Healthcare Provider Details

I. General information

NPI: 1346659828
Provider Name (Legal Business Name): GLADES MEDICAL CENTERS, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

IV. Provider business mailing address

1 N.E. 167TH STREET
NORTH MIAMI BEACH FL
33162
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9565
  • Fax: 305-432-9567
Mailing address:
  • Phone: 305-432-9565
  • Fax: 305-432-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOUHA CHAMOUN
Title or Position: CEO
Credential:
Phone: 305-432-9565