Provider Demographics
NPI:1801219258
Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC
Other - Org Name:TAVERNIER COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-252-4853
Mailing Address - Street 1:10300 SW 216 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1003
Mailing Address - Country:US
Mailing Address - Phone:305-253-5100
Mailing Address - Fax:305-252-5881
Practice Address - Street 1:91200 OVERSEAS HWY
Practice Address - Street 2:#17
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2500
Practice Address - Country:US
Practice Address - Phone:305-253-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010762301Medicaid
FL060303110Medicaid
FL010762328Medicaid