Provider Demographics
NPI:1629719471
Name:GARNET HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:GARNET HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MOTUNRAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:305-370-9023
Mailing Address - Street 1:19821 NW 2ND AVE # 158
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3341
Mailing Address - Country:US
Mailing Address - Phone:305-370-9023
Mailing Address - Fax:
Practice Address - Street 1:156 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-1716
Practice Address - Country:US
Practice Address - Phone:305-370-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care