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General NPI Number Information
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NPI Number | 1669983300
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Entity Type | Organization
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Legal Business Name | HOMESTEAD RESEARCH MENTAL HEALTH INC
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 317 N KROME AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-6057
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Country | US
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Telephone | 305-257-8065
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Fax | 305-508-6502
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Provider Business Mailing Address
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Address Line | 317 N KROME AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-6057
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Country | US
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Telephone | 305-257-8065
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Fax | 305-508-6502
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. WALEEM ENRIQUE HERNANDEZ
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Credential |
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Telephone | 305-257-8065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PENDING
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License Number State |
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