Provider Demographics
NPI:1124569280
Name:WEST KENDALL COMMUNITY CENTER
Entity Type:Organization
Organization Name:WEST KENDALL COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ADANNYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-744-4525
Mailing Address - Street 1:13255 SW 137TH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5326
Mailing Address - Country:US
Mailing Address - Phone:305-744-4525
Mailing Address - Fax:
Practice Address - Street 1:13255 SW 137TH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5326
Practice Address - Country:US
Practice Address - Phone:305-744-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management