1588021679 NPI number — FAMILY SOLUTIONS CENTER, LLC

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 1588021679 NPI number — FAMILY SOLUTIONS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SOLUTIONS CENTER, LLC
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:
1588021679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 IVES DAIRY RD STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33179-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-306-5534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 IVES DAIRY RD STE 228
Provider Second Line Business Practice Location Address:
OFFICE 214
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33179-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-306-5534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LEAL
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL SUPERVISOR
Authorized Official Telephone Number:
786-306-5534

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: MT2528 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 118221100 . 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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