Healthcare Provider Details

I. General information

NPI: 1699014100
Provider Name (Legal Business Name): COMMUNNITY HEALTH OF SOUTH FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SW 152ND AVE
MIAMI FL
33193-2169
US

IV. Provider business mailing address

10300 SW 216TH ST
CUTLER BAY FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • 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: MR. BRODES H HARTLEY JR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-252-4853