Provider Demographics
NPI:1275156259
Name:MJD WELLNESS AND COMMUNITY CENTER INC
Entity Type:Organization
Organization Name:MJD WELLNESS AND COMMUNITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUERIMONT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:786-406-5886
Mailing Address - Street 1:1151 NW 126TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6441
Mailing Address - Country:US
Mailing Address - Phone:786-406-5886
Mailing Address - Fax:
Practice Address - Street 1:822 NE 125TH ST STE 103
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5729
Practice Address - Country:US
Practice Address - Phone:786-406-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care