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General NPI Number Information
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NPI Number | 1932773322
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH CARE CLINIC LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1031 IVES DAIRY RD STE 228
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City | MIAMI
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State | FL
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Zip | 33179-2538
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Country | US
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Telephone | 561-633-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 IVES DAIRY RD STE 228
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City | MIAMI
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State | FL
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Zip | 33179-2538
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Country | US
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Telephone | 561-633-9037
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Fax |
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Authorized Official
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Title or Position | CONSULTANT NURSE
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Name | BERNARD O SPOONER
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Credential | RN
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Telephone | 813-992-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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