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General NPI Number Information
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NPI Number | 1992546386
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Entity Type | Organization
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Legal Business Name | PRIDELINES YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 5525 NW 7TH AVE
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City | MIAMI
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State | FL
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Zip | 33127-1401
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Country | US
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Telephone | 305-571-9601
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14340
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City | MIAMI
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State | FL
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Zip | 33101-4340
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Country | US
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Telephone | 305-571-9601
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. EDWARD SUMMERS
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Credential | PH.D.
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Telephone | 347-468-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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