Healthcare Provider Details

I. General information

NPI: 1952878290
Provider Name (Legal Business Name): COMMUNITY WINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 SW 88TH ST STE 110
MIAMI FL
33186-1513
US

IV. Provider business mailing address

3850 SW 87TH AVE STE 102
MIAMI FL
33165-5472
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-4443
  • Fax:
Mailing address:
  • Phone: 786-615-4443
  • Fax: 786-391-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: PEDRO ROMANACH LEIVA
Title or Position: PRESIDENT
Credential: OFFICER
Phone: 786-547-3749