Healthcare Provider Details

I. General information

NPI: 1952486219
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MIAMI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 NW 2ND AVE
MIAMI FL
33150-2901
US

IV. Provider business mailing address

7707 NW 2ND AVE
MIAMI FL
33150-2901
US

V. Phone/Fax

Practice location:
  • Phone: 305-795-0077
  • Fax: 305-795-2022
Mailing address:
  • Phone: 305-795-0077
  • Fax: 305-795-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberMT 1646
License Number StateFL

VIII. Authorized Official

Name: SANDRA VALDES
Title or Position: PROGRAM DIRECTOR
Credential: LCSW, MSW
Phone: 305-795-0077