Provider Demographics
NPI:1710280573
Name:DADELAND NORTH MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:DADELAND NORTH MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-2290
Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:SUITE 234
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:305-828-2290
Mailing Address - Fax:305-828-2263
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:SUITE 234
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:305-828-2290
Practice Address - Fax:305-828-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8978261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC8978OtherAHCA LICENSE