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General NPI Number Information
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NPI Number | 1740453711
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Entity Type | Organization
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Legal Business Name | NEW LIFE COMMUNITY MENTAL CENTER, LLC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1690 NW 19TH TERRACE
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City | MIAMI
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State | FL
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Zip | 33125
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Country | US
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Telephone | 305-325-8620
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Fax | 305-324-3347
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Provider Business Mailing Address
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Address Line | 1690 NW 19TH TERRACE
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City | MIAMI
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State | FL
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Zip | 33125
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Country | US
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Telephone | 305-325-8620
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Fax | 305-324-3347
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT GARCIA
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Credential |
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Telephone | 305-325-8620
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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 | HCCS111
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License Number State | FL
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