Provider Demographics
NPI:1417330960
Name:FIRST IMPRESSIONS CUMMUNITY DEVELOPMENT CORP.
Entity Type:Organization
Organization Name:FIRST IMPRESSIONS CUMMUNITY DEVELOPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHATARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES-MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-525-7946
Mailing Address - Street 1:20101 NW 34TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1768
Mailing Address - Country:US
Mailing Address - Phone:305-525-7946
Mailing Address - Fax:305-620-1614
Practice Address - Street 1:20101 NW 34TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1768
Practice Address - Country:US
Practice Address - Phone:305-525-7946
Practice Address - Fax:305-620-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA0600X, 320600000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities