Healthcare Provider Details

I. General information

NPI: 1578522967
Provider Name (Legal Business Name): JEWISH COMMUNITY SERVICES OF S.FL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 SW 104TH ST STE 101
MIAMI FL
33156-2642
US

IV. Provider business mailing address

7875 SW 104TH ST STE 101
MIAMI FL
33156-2642
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-8998
  • Fax: 305-899-6367
Mailing address:
  • Phone: 305-740-8998
  • Fax: 305-899-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SIXTO MONTANO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 305-403-6513