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General NPI Number Information
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NPI Number | 1760793145
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Entity Type | Organization
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Legal Business Name | LORD FAMILY SERVICE INC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 2604 W 84TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-5703
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Country | US
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Telephone | 305-824-8888
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Fax | 305-824-8854
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Provider Business Mailing Address
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Address Line | 2604 W 84TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-5703
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Country | US
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Telephone | 305-824-8888
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Fax | 305-824-8854
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAFAEL MEANA
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Credential | M.A
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Telephone | 305-824-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | HCC8222
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License Number State | FL
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