Healthcare Provider Details

I. General information

NPI: 1912508912
Provider Name (Legal Business Name): ALTAMIRA COMMUNITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 NE 8TH AVE
NORTH MIAMI FL
33161-4965
US

IV. Provider business mailing address

12540 NE 8TH AVE
NORTH MIAMI FL
33161-4965
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-2072
  • Fax:
Mailing address:
  • Phone: 786-521-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAYSI A HERRERA
Title or Position: OWNER
Credential:
Phone: 786-521-2072