MEDICARE: ESTHER LOUISE COMMUNITY MENTAL HEALTH CENTER

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	251S00000X	Community/Behavioral Health Agency		FL

General Provider Information

NPI Number	:	1598807570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTHER LOUISE COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	9505 07 09 NORTH WEST 27 AVENUE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147
Country	:	US
Telephone Number	:	305-693-9488
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 07 09 NORTH WEST 27 AVENUE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147
Country	:	US
Telephone Number	:	305-693-9488
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR CEO
Name	:	MRS. ESTHER LOUISE LEGER
Credential	:	CEO
Telephone Number	:	305-693-9488

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/21/2022

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