Provider Demographics
NPI:1003234626
Name:MIAMI-DADE COUNTY COMMUNITY ACTION AND HUMAN SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:MIAMI-DADE COUNTY COMMUNITY ACTION AND HUMAN SERVICES DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF, ELDERLY SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDELINE
Authorized Official - Middle Name:BEAUVAIS
Authorized Official - Last Name:MONDESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:786-469-4600
Mailing Address - Street 1:150 NW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-3016
Mailing Address - Country:US
Mailing Address - Phone:305-751-4342
Mailing Address - Fax:
Practice Address - Street 1:150 NW 79TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-3016
Practice Address - Country:US
Practice Address - Phone:305-751-4342
Practice Address - Fax:305-759-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL670671100Medicaid