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General NPI Number Information
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NPI Number | 1114991544
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Entity Type | Organization
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Legal Business Name | DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC.
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 1680 MERIDIAN AVE SUITE 501
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City | MIAMI BEACH
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State | FL
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Zip | 33139
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Country | US
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Telephone | 305-531-5341
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Fax | 305-532-5322
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Provider Business Mailing Address
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Address Line | 1680 MERIDIAN AVE STE 501
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City | MIAMI BEACH
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State | FL
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Zip | 33139-2719
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Country | US
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Telephone | 305-531-5341
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Fax | 305-532-5322
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Authorized Official
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Title or Position | CFO
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Name | LARRY J LONG
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Credential | MACC
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Telephone | 305-531-5341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | KH909
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | KH909
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | KH909
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | KH909
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License Number State | FL
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