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General NPI Number Information
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NPI Number | 1417330960
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Entity Type | Organization
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Legal Business Name | FIRST IMPRESSIONS CUMMUNITY DEVELOPMENT CORP.
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 20101 NW 34TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1768
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Country | US
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Telephone | 305-525-7946
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Fax | 305-620-1614
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Provider Business Mailing Address
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Address Line | 20101 NW 34TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1768
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Country | US
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Telephone | 305-525-7946
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Fax | 305-620-1614
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHATARIA BRIDGES-MOSS
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Credential |
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Telephone | 305-525-7946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | FL
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