Provider Demographics
NPI:1932663671
Name:GANG ALTERNATIVE, INC.
Entity Type:Organization
Organization Name:GANG ALTERNATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOZILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-391-2375
Mailing Address - Street 1:12000 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2735
Mailing Address - Country:US
Mailing Address - Phone:756-391-2379
Mailing Address - Fax:
Practice Address - Street 1:6620 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4524
Practice Address - Country:US
Practice Address - Phone:786-391-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1036620OtherDCF