Healthcare Provider Details

I. General information

NPI: 1275156259
Provider Name (Legal Business Name): MJD WELLNESS AND COMMUNITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 NE 125TH ST STE 103
NORTH MIAMI FL
33161-5729
US

IV. Provider business mailing address

822 NE 125TH ST STE 103
NORTH MIAMI FL
33161-5729
US

V. Phone/Fax

Practice location:
  • Phone: 786-406-5886
  • Fax:
Mailing address:
  • Phone: 786-534-3896
  • Fax: 786-431-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMMANUELLA FLUERIMONT
Title or Position: CEO
Credential: BS
Phone: 786-406-5886