1073563235 NPI number — MONEF HEALTH SERVICES, INC.

Table of content: (NPI 1073563235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073563235 NPI number — MONEF HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONEF HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073563235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 NW 183RD STREET
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-999-0520
Provider Business Mailing Address Fax Number:
305-999-0521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 NW 183RD STREET
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
MIAMI GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-999-0520
Provider Business Practice Location Address Fax Number:
305-999-0521
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESSIET
Authorized Official First Name:
NSE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-710-7375

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA21840096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650632198 . This is a "FAMILY SUPPORT LIVING" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650632196 . This is a "MEDICAID WAIVER: DEVELOPM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650632100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 676632300 . This is a "PROJECT AIDS NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650632102 . This is a "MEDICAID WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650632179 . This is a "BRAIN & SPINAL CORD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650632100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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