Healthcare Provider Details

I. General information

NPI: 1174575708
Provider Name (Legal Business Name): IMPROVING LIVES COMMUNITY MENTAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 SW 62ND AVE STE 300
SOUTH MIAMI FL
33143-4723
US

IV. Provider business mailing address

7171 SW 62ND AVE STE 300
SOUTH MIAMI FL
33143-4723
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-5305
  • Fax: 305-270-5306
Mailing address:
  • Phone: 305-270-5305
  • Fax: 305-270-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberHCC5151
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO HERNANDEZ
Title or Position: CLINICAL DIRECTOR
Credential: M.S, LMHC
Phone: 305-270-5305