Provider Demographics
NPI:1568894111
Name:MIAMI BRIDGE YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MIAMI BRIDGE YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CRC
Authorized Official - Phone:305-636-3520
Mailing Address - Street 1:2810 NW SOUTH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1120
Mailing Address - Country:US
Mailing Address - Phone:305-635-8953
Mailing Address - Fax:305-636-3521
Practice Address - Street 1:326 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5805
Practice Address - Country:US
Practice Address - Phone:305-246-8956
Practice Address - Fax:305-242-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100029078251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health