Healthcare Provider Details

I. General information

NPI: 1821411232
Provider Name (Legal Business Name): COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 MATILDA ST
MIAMI FL
33133-5138
US

IV. Provider business mailing address

10300 SW 216TH STREET
MIAMI FL
33190-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-7768
  • Fax:
Mailing address:
  • Phone: 305-253-5100
  • Fax: 305-254-4987

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: PRESIDENT/CEO
Credential:
Phone: 305-253-5100