Provider Demographics
NPI:1750827531
Name:PROFESSIONALS CARING FOR HUMANITY INC
Entity Type:Organization
Organization Name:PROFESSIONALS CARING FOR HUMANITY INC
Other - Org Name:PROFESSIONALS CARING FOR HUMANITY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DCP
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:305-644-4410
Mailing Address - Street 1:10 NW 42ND AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5475
Mailing Address - Country:US
Mailing Address - Phone:305-644-4410
Mailing Address - Fax:305-644-0114
Practice Address - Street 1:9421 S ORANGE BLOSSOM TRL # 19
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8320
Practice Address - Country:US
Practice Address - Phone:407-601-2527
Practice Address - Fax:407-674-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty