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General NPI Number Information
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NPI Number | 1972729846
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Entity Type | Organization
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Legal Business Name | PASSAGEWAY
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2255 NW 10TH AVE
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City | MIAMI
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State | FL
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Zip | 33127-4219
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Country | US
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Telephone | 305-635-9106
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Fax | 305-635-4687
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Provider Business Mailing Address
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Address Line | 2255 NW 10TH AVE
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City | MIAMI
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State | FL
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Zip | 33127-4919
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Country | US
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Telephone | 305-635-9106
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Fax | 305-635-4687
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Authorized Official
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Title or Position | CASE MANAGER
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Name | EMIL G HAZIM
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Credential |
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Telephone | 305-445-4991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 8332
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License Number State | FL
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