MEDICARE: SOUL HEALTH CENTER LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1942041652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	5911 NW 173RD DR
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-5121
Country	:	US
Telephone Number	:	786-307-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	5911 NW 173RD DR
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-5121
Country	:	US
Telephone Number	:	786-307-8253
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUGDADES LEBRIGIO SALGADO
Credential	:
Telephone Number	:	786-308-8253

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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Directions to “SOUL HEALTH CENTER LLC ” Practice Location

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