Provider Demographics
NPI:1285688705
Name:SUDDEN CARE OPTIONS CMHC INC
Entity Type:Organization
Organization Name:SUDDEN CARE OPTIONS CMHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:PENA
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-229-9021
Mailing Address - Street 1:1421 SW 107TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2509
Mailing Address - Country:US
Mailing Address - Phone:305-229-9021
Mailing Address - Fax:305-229-9031
Practice Address - Street 1:1421 SW 107TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2509
Practice Address - Country:US
Practice Address - Phone:305-229-9021
Practice Address - Fax:305-229-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5199261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101473Medicare Oscar/Certification