1255918942 NPI number — CORAL WAY HEALTH CENTER CORP

Table of content: (NPI 1255918942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255918942 NPI number — CORAL WAY HEALTH CENTER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORAL WAY HEALTH CENTER CORP
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:
1255918942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9159 SW 87TH AVE
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:
33176-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-392-1274
Provider Business Mailing Address Fax Number:
786-953-5752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12855 SW 132ND ST STE 207A
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:
33186-7207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-608-5572
Provider Business Practice Location Address Fax Number:
786-250-5094
Provider Enumeration Date:
03/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
GISELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-392-1274

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HCC12527 . This is a "AHCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 109994700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com