Healthcare Provider Details

I. General information

NPI: 1134116320
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 22ND AVE
MIAMI FL
33142-8429
US

IV. Provider business mailing address

2500 NW 22ND AVE
MIAMI FL
33142-8429
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-3000
  • Fax: 305-638-6856
Mailing address:
  • Phone: 786-466-3000
  • Fax: 305-638-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1243096
License Number StateFL

VIII. Authorized Official

Name: MR. CARLOS MIGOYA
Title or Position: CEO
Credential:
Phone: 305-585-3701