1659536365 NPI number — CAMILLUS HEALTH CONCERN, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659536365 NPI number — CAMILLUS HEALTH CONCERN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMILLUS HEALTH CONCERN, 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:
SALVATION ARMY
Provider Other Organization Name Type Code:
5
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:
1659536365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
336 NW 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33128-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-577-4840
Provider Business Mailing Address Fax Number:
305-373-7431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1907 NW 38TH ST STE 195
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33142-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-637-6720
Provider Business Practice Location Address Fax Number:
305-635-1123
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AFRAM-GYENING
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
305-533-0189

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 680002514 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 680002505 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 680002517 . 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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