Healthcare Provider Details

I. General information

NPI: 1487657516
Provider Name (Legal Business Name): HELEN B BENTLEY FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 SW 37TH AVE
MIAMI FL
33133-4311
US

IV. Provider business mailing address

3090 SW 37TH AVE
MIAMI FL
33133-4311
US

V. Phone/Fax

Practice location:
  • Phone: 305-447-4950
  • Fax: 305-444-7866
Mailing address:
  • Phone: 305-447-4950
  • Fax: 305-444-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number719670
License Number StateFL

VIII. Authorized Official

Name: DR. CALEB A DAVIS
Title or Position: PRESIDENT CEO
Credential: PHD
Phone: 305-351-1314