Provider Demographics
NPI:1245581917
Name:CITRUS HEALTH NETWORK INC
Entity Type:Organization
Organization Name:CITRUS HEALTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:JARDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-424-3100
Mailing Address - Street 1:4175 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5874
Mailing Address - Country:US
Mailing Address - Phone:305-825-0300
Mailing Address - Fax:305-818-1885
Practice Address - Street 1:60 E 3RD ST
Practice Address - Street 2:SUITE 102C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4917
Practice Address - Country:US
Practice Address - Phone:786-441-5330
Practice Address - Fax:786-209-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)