Healthcare Provider Details

I. General information

NPI: 1225176621
Provider Name (Legal Business Name): TRAUMA RESOLUTION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BISCAYNE BLVD SUITE 210
MIAMI FL
33137-4130
US

IV. Provider business mailing address

3000 BISCAYNE BLVD SUITE 210
MIAMI FL
33137-4130
US

V. Phone/Fax

Practice location:
  • Phone: 305-374-9990
  • Fax: 305-374-9995
Mailing address:
  • Phone: 305-374-9990
  • Fax: 305-374-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1113AD774101
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1113AD774101
License Number StateFL

VIII. Authorized Official

Name: TERESA DESCILO
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 305-374-9990