Provider Demographics
NPI:1871654632
Name:MIRACLE MILE COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MIRACLE MILE COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-324-9494
Mailing Address - Street 1:955 NW 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1281
Mailing Address - Country:US
Mailing Address - Phone:305-324-9494
Mailing Address - Fax:305-324-9491
Practice Address - Street 1:955 NW 3RD ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1281
Practice Address - Country:US
Practice Address - Phone:305-324-9494
Practice Address - Fax:305-324-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101463Medicare Oscar/Certification
FL101463Medicare ID - Type UnspecifiedPARTIAL HOSPITALIZATION