MEDICARE: LIGHTHOUSE CMHC OF NORTH DADE

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)	HCC6036	FL

General Provider Information

NPI Number	:	1972722403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE CMHC OF NORTH DADE

Provider Business Mailing Address
First Line	:	1901 NW 7TH ST
Second Line	:	SUITE 108
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-817-5601
Fax Number	:	305-817-5602

Provider Business Practice Location Address
First Line	:	1901 NW 7TH ST
Second Line	:	SUITE 108
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-817-5601
Fax Number	:	305-817-5602

Authorized Official
Title or Position	:	CEO
Name	:	MR. FRANCISCO J LLAUDY
Credential	:
Telephone Number	:	305-817-5601

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/30/2007

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