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General NPI Number Information
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NPI Number | 1801049689
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH OF SOUTH FL, INC
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 13805 SW 264TH ST
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City | NARANJA
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State | FL
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Zip | 33032-7602
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Country | US
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Telephone | 305-264-5745
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Fax |
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Provider Business Mailing Address
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Address Line | 13805 SW 264TH ST
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City | NARANJA
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State | FL
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Zip | 33032-7602
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Country | US
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Telephone | 305-264-5745
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. BRODES H HARTLEY JR.
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Credential |
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Telephone | 305-252-4850
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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 | PH23885
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License Number State | FL
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