Provider Demographics
NPI:1376532150
Name:THE VILLAGE SOUTH, INC
Entity Type:Organization
Organization Name:THE VILLAGE SOUTH, INC
Other - Org Name:THE VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR SPECIAL PROJECTS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-586-4654
Mailing Address - Street 1:1633 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4587
Mailing Address - Country:US
Mailing Address - Phone:315-573-3784
Mailing Address - Fax:
Practice Address - Street 1:1633 POINCIANA DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4587
Practice Address - Country:US
Practice Address - Phone:315-573-3784
Practice Address - Fax:305-576-1348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113AD273613251S00000X
FL113AD273612251S00000X
FL113AD273650251S00000X
FL1113AD273605261QR0405X
FL1113AD273606261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0605905 00Medicaid