Healthcare Provider Details

I. General information

NPI: 1013959972
Provider Name (Legal Business Name): JACKSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

759 NW 174TH AVE
PEMBROKE PINES FL
33029-3145
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5513
  • Fax:
Mailing address:
  • Phone: 305-798-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1735652
License Number StateFL

VIII. Authorized Official

Name: ROXANNE CESPEDES
Title or Position: DIRECTOR CARE-A-VAN
Credential:
Phone: 305-585-5513