Provider Demographics
NPI:1114370509
Name:CENTRAL HEALTH CORP
Entity Type:Organization
Organization Name:CENTRAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-0356
Mailing Address - Street 1:13550 SW 88TH ST
Mailing Address - Street 2:290
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1654
Mailing Address - Country:US
Mailing Address - Phone:305-559-0356
Mailing Address - Fax:305-559-0376
Practice Address - Street 1:13550 SW 88TH ST
Practice Address - Street 2:290
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1654
Practice Address - Country:US
Practice Address - Phone:305-559-0356
Practice Address - Fax:305-559-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10693261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center