Provider Demographics
NPI:1972030443
Name:THE ARC OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:THE ARC OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:MAIYARELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:239-810-8903
Mailing Address - Street 1:720 SE 12TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5093
Mailing Address - Country:US
Mailing Address - Phone:239-810-8903
Mailing Address - Fax:
Practice Address - Street 1:720 SE 12TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5093
Practice Address - Country:US
Practice Address - Phone:239-810-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27580305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization