Healthcare Provider Details

I. General information

NPI: 1396235347
Provider Name (Legal Business Name): ALASAKE MENTAL HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 191A
MIAMI FL
33122-1084
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 191
DORAL FL
33122-1084
US

V. Phone/Fax

Practice location:
  • Phone: 786-401-7579
  • Fax: 786-409-5790
Mailing address:
  • Phone: 786-631-3152
  • Fax: 786-631-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberP236200827620
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALFONSO ALFONSO
Title or Position: PRESIDENT
Credential:
Phone: 786-205-8684