MEDICARE: NORTH DADE CHRISTIAN SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		FL

General Provider Information

NPI Number	:	1043675572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DADE CHRISTIAN SCHOOL

Provider Business Mailing Address
First Line	:	1505 NW 167TH ST FL 4
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5133
Country	:	US
Telephone Number	:	305-328-9103
Fax Number	:	305-328-9103

Provider Business Practice Location Address
First Line	:	1505 NW 167TH ST FL 4
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5133
Country	:	US
Telephone Number	:	305-328-9103
Fax Number	:	305-328-9103

Authorized Official
Title or Position	:	MEDICAL RECORDS CUSTODIAN
Name	:	MS. MARIA BOWIE
Credential	:
Telephone Number	:	305-328-9103

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/29/2015

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Directions to “NORTH DADE CHRISTIAN SCHOOL ” Practice Location

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