Provider Demographics
NPI:1124418264
Name:TARGETED CM
Entity Type:Organization
Organization Name:TARGETED CM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-666-0418
Mailing Address - Street 1:2300 W 84TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5770
Mailing Address - Country:US
Mailing Address - Phone:786-666-0418
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5770
Practice Address - Country:US
Practice Address - Phone:786-666-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)