=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033537667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI-DADE COUNTY COMMUNITY ACTION AND HUMAN SERVICES DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2014
-----------------------------------------------------
Last Update Date | 04/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6950 N WATERWAY DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-267-6372
-----------------------------------------------------
Fax | 305-267-6364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6950 N WATERWAY DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-267-6372
-----------------------------------------------------
Fax | 305-267-6364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACTING CHIEF, ELDERLY SERVICES
-----------------------------------------------------
Name | MRS. EDELINE BEAUVAIS MONDESTIN
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 786-469-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 8978
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------