Provider Demographics
NPI:1467719955
Name:MIAMI COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:MIAMI COMMUNITY HEALTH CENTER, INC
Other - Org Name:LA MILAGROSA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-586-3417
Mailing Address - Street 1:891-893 EAST 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-6355
Mailing Address - Country:US
Mailing Address - Phone:786-220-2029
Mailing Address - Fax:786-220-2094
Practice Address - Street 1:891-893 EAST 10TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010
Practice Address - Country:US
Practice Address - Phone:305-381-5150
Practice Address - Fax:305-851-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9412261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC9412OtherAHCA HEALTH CARE CLINIC