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General NPI Number Information
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NPI Number | 1609540681
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Entity Type | Organization
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Legal Business Name | SOCIAL DIVERSITY LLC
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 11/05/2022
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Provider Practice Location Address
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Address Line | 12001 SW 128TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-4665
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Country | US
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Telephone | 786-975-7485
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Fax | 954-860-7166
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Provider Business Mailing Address
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Address Line | 382 NE 19TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33033-5265
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Country | US
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Telephone | 786-975-7485
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Fax | 954-860-7166
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Authorized Official
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Title or Position | CEO
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Name | ESEL AGUILAR
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Credential | OWNER/TCM SUPERVISOR
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Telephone | 786-975-7485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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