Provider Demographics
NPI:1467745505
Name:SOUTH FLORIDA HEALTH GROUP CORP
Entity Type:Organization
Organization Name:SOUTH FLORIDA HEALTH GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-249-7701
Mailing Address - Street 1:3900 WOODLAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3044
Mailing Address - Country:US
Mailing Address - Phone:561-249-7701
Mailing Address - Fax:561-249-7708
Practice Address - Street 1:3900 WOODLAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3044
Practice Address - Country:US
Practice Address - Phone:561-249-7701
Practice Address - Fax:561-249-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9152261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 9645OtherAHCA HCC UNIT