Provider Demographics
NPI:1538707252
Name:INNER CITY DANCE CLUB OF MIAMI CORPORATION
Entity Type:Organization
Organization Name:INNER CITY DANCE CLUB OF MIAMI CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-726-5075
Mailing Address - Street 1:1290 NW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4336
Mailing Address - Country:US
Mailing Address - Phone:305-726-5075
Mailing Address - Fax:
Practice Address - Street 1:6161 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-1013
Practice Address - Country:US
Practice Address - Phone:305-726-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty