Provider Demographics
NPI:1558432542
Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type:Organization
Organization Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Other - Org Name:JACKSON MEMORIAL PERDUE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:786-466-3500
Mailing Address - Street 1:19590 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8048
Mailing Address - Country:US
Mailing Address - Phone:786-466-3500
Mailing Address - Fax:305-233-8296
Practice Address - Street 1:19590 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-8048
Practice Address - Country:US
Practice Address - Phone:786-466-3500
Practice Address - Fax:305-233-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1435096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020367000Medicaid
FL020367000Medicaid