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General NPI Number Information
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NPI Number | 1720515513
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Entity Type | Organization
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Legal Business Name | IBEACON COMMUNITY SERVICES CORP.
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 571 SW 71ST PL
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City | MIAMI
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State | FL
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Zip | 33144-2753
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Country | US
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Telephone | 786-657-1607
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Fax |
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Provider Business Mailing Address
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Address Line | 571 SW 71ST PL
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City | MIAMI
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State | FL
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Zip | 33144-2753
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Country | US
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Telephone | 786-657-1607
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NOEL PEDRAZA ALONSO
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Credential |
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Telephone | 786-657-1607
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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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