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General NPI Number Information
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NPI Number | 1932543634
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Entity Type | Organization
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Legal Business Name | FIRST IMPRESSIONS COMMUNITY DEVELOPEMENT CORP.
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 13366 SW 288TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33033-1927
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Country | US
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Telephone | 561-572-6250
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Fax | 305-248-4284
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Provider Business Mailing Address
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Address Line | 20101 NW 34TH CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-1768
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Country | US
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Telephone | 561-572-6250
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Fax | 305-248-4284
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHATARIA BRIDGES MOSS
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Credential |
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Telephone | 561-572-6250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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 | FL
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