Provider Demographics
NPI:1760739270
Name:MIAMI GARDENS HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:MIAMI GARDENS HEALTH CLINIC, LLC
Other - Org Name:NP HOME VISITING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-333-3872
Mailing Address - Street 1:13196 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5527
Mailing Address - Country:US
Mailing Address - Phone:305-333-3872
Mailing Address - Fax:
Practice Address - Street 1:13196 SW 50TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5527
Practice Address - Country:US
Practice Address - Phone:305-333-3872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1952242261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service