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General NPI Number Information
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NPI Number | 1568503456
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Entity Type | Organization
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Legal Business Name | MACTOWN, INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6250 NE 1ST PL
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City | MIAMI
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State | FL
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Zip | 33138-5904
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Country | US
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Telephone | 305-758-4485
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Fax | 305-759-8445
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Provider Business Mailing Address
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Address Line | 151 NE 62ND ST
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City | MIAMI
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State | FL
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Zip | 33138-5926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ICF ADMINISTRATOR
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Name | ALLA FELDBEYN
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Credential |
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Telephone | 305-758-4485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 4045095
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License Number State | FL
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