=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578195715
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINLAY COMMUNITY SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2020
-----------------------------------------------------
Last Update Date | 05/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7620 NW 25TH ST STE 1
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-441-2851
-----------------------------------------------------
Fax | 784-244-5887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7620 NW 25TH ST STE 1
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-487-5135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MARK MEDINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-487-5135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------