Healthcare Provider Details

I. General information

NPI: 1962790535
Provider Name (Legal Business Name): J & C NETWORK RESOURCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 NE 148TH ST
NORTH MIAMI FL
33181-1021
US

IV. Provider business mailing address

1620 NE 148TH ST
NORTH MIAMI FL
33181-1021
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-6445
  • Fax:
Mailing address:
  • Phone: 305-705-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TERRY LENO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 786-298-7379