Provider Demographics
NPI:1952486219
Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MIAMI, INC.
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MIAMI, INC.
Other - Org Name:ST. LUKE'S CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSW
Authorized Official - Phone:305-795-0077
Mailing Address - Street 1:7707 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2901
Mailing Address - Country:US
Mailing Address - Phone:305-795-0077
Mailing Address - Fax:305-795-2022
Practice Address - Street 1:7707 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2901
Practice Address - Country:US
Practice Address - Phone:305-795-0077
Practice Address - Fax:305-795-2022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MIAMI, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1646324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0606103-00Medicaid