Healthcare Provider Details

I. General information

NPI: 1508010323
Provider Name (Legal Business Name): COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 147TH AVE
MIAMI FL
33185-3916
US

IV. Provider business mailing address

10300 SW 216TH ST
MIAMI FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-6205
  • Fax:
Mailing address:
  • Phone: 305-253-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRODES H HARTLEY JR.
Title or Position: CEO
Credential:
Phone: 305-253-5100