=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396235347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALASAKE MENTAL HEALTH SERVICES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2018
-----------------------------------------------------
Last Update Date | 12/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 NW 79TH AVE STE 191A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-401-7579
-----------------------------------------------------
Fax | 786-409-5790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 NW 79TH AVE STE 191
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-631-3152
-----------------------------------------------------
Fax | 786-631-3140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALFONSO ALFONSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-205-8684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | P236200827620
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------