Provider Demographics
NPI: | 1003409707 |
---|---|
Name: | CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA, LLC |
Entity Type: | Organization |
Organization Name: | CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-628-6117 |
Mailing Address - Street 1: | 1395 NW 167TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI GARDENS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33169-5710 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-628-6117 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 390 S. STATE ROAD 7 |
Practice Address - Street 2: | |
Practice Address - City: | HOLLYWOOD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33023 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-743-5522 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CHEN NEIGHBORHOOD MEDICAL CENTERS OF SOUTH FLORIDA, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2021-02-15 |
Last Update Date: | 2021-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |