Provider Demographics
NPI:1417695917
Name:ALTAMIRA COMMUNITY CENTER LLC
Entity Type:Organization
Organization Name:ALTAMIRA COMMUNITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAYSI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-521-2072
Mailing Address - Street 1:12540 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4965
Mailing Address - Country:US
Mailing Address - Phone:786-731-6492
Mailing Address - Fax:
Practice Address - Street 1:1500 COLONIAL BLVD STE 216
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1026
Practice Address - Country:US
Practice Address - Phone:786-731-6492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)