Provider Demographics
NPI:1043675572
Name:NORTH DADE CHRISTIAN SCHOOL
Entity Type:Organization
Organization Name:NORTH DADE CHRISTIAN SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS CUSTODIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-328-9103
Mailing Address - Street 1:1505 NW 167TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5133
Mailing Address - Country:US
Mailing Address - Phone:305-328-9103
Mailing Address - Fax:305-328-9103
Practice Address - Street 1:1505 NW 167TH ST FL 4
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5133
Practice Address - Country:US
Practice Address - Phone:305-328-9103
Practice Address - Fax:305-328-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid
FL=========Medicaid