Provider Demographics
NPI:1659817492
Name:CERCA DE LUZ, INC.
Entity Type:Organization
Organization Name:CERCA DE LUZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:305-517-3142
Mailing Address - Street 1:1348 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1908
Mailing Address - Country:US
Mailing Address - Phone:305-517-3142
Mailing Address - Fax:
Practice Address - Street 1:1348 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326-1908
Practice Address - Country:US
Practice Address - Phone:305-517-3142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty