Provider Demographics
NPI:1245801091
Name:ACTIVE COMMUNITY HEALTH CENTER CORP
Entity Type:Organization
Organization Name:ACTIVE COMMUNITY HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:URIARTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-394-3095
Mailing Address - Street 1:19321 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6124
Mailing Address - Country:US
Mailing Address - Phone:954-394-3095
Mailing Address - Fax:954-333-8621
Practice Address - Street 1:6830 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-7545
Practice Address - Country:US
Practice Address - Phone:954-333-8787
Practice Address - Fax:954-333-8621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE COMMUNITY HEALTH CENTER, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-02
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008779301Medicaid