1023497104 NPI number — NANI'S PLACE: CENTER FOR HEALING & WHOLENESS

Table of content: (NPI 1023497104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023497104 NPI number — NANI'S PLACE: CENTER FOR HEALING & WHOLENESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANI'S PLACE: CENTER FOR HEALING & WHOLENESS
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:
1023497104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 SW 81ST DR
Provider Second Line Business Mailing Address:
STE. 290
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143-6603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-270-7968
Provider Business Mailing Address Fax Number:
305-270-2540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 SW 81ST DR
Provider Second Line Business Practice Location Address:
STE. 290
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-270-7968
Provider Business Practice Location Address Fax Number:
305-270-2540
Provider Enumeration Date:
05/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SOLARES
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
LICENSED MENTAL HEALTH COUNSELOR
Authorized Official Telephone Number:
305-270-7968

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MS10620 , 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: 010160100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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