Provider Demographics
NPI:1508010323
Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Other - Org Name:G. HOLMES BRADDOCK SENIOR HIGH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRODES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-253-5100
Mailing Address - Street 1:10300 SW 216TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1003
Mailing Address - Country:US
Mailing Address - Phone:305-253-5100
Mailing Address - Fax:
Practice Address - Street 1:3601 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3916
Practice Address - Country:US
Practice Address - Phone:305-552-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029572837 - FQHCMedicaid
FL029572849 - FFSMedicaid