Provider Demographics
NPI:1578814265
Name:JACKSON SOUTH COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:JACKSON SOUTH COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR OF PATIENTS CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYSI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-256-5311
Mailing Address - Street 1:5850 NW 191ST TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5036
Mailing Address - Country:US
Mailing Address - Phone:305-558-8826
Mailing Address - Fax:
Practice Address - Street 1:9333 SW 152 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-256-5311
Practice Address - Fax:305-256-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2950782283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital