Provider Demographics
NPI:1790046258
Name:UNITED CEREBRAL PALSY OF MIAMI
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF MIAMI
Other - Org Name:UNITED CEREBRAL PALSY OF MIAMI
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-947-7261
Mailing Address - Street 1:1411 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1616
Mailing Address - Country:US
Mailing Address - Phone:305-325-1080
Mailing Address - Fax:305-728-1501
Practice Address - Street 1:1411 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1616
Practice Address - Country:US
Practice Address - Phone:305-325-1080
Practice Address - Fax:305-728-1501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED CEREBRAL PALSY OF MIAMI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP510793716750302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization