=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255955357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FED HELP MEDICAL OF WEST BROWARD CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2020
-----------------------------------------------------
Last Update Date | 05/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11430 N KENDALL DR STE 106
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-312-0359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11430 N KENDALL DR STE 106
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-312-0359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YARISBEL GALLARDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-703-1605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------