Provider Demographics
NPI:1336152347
Name:COMMUNITY HEALTH OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRODES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-253-5100
Mailing Address - Street 1:10300 SW 216TH STREET
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:
Practice Address - Street 1:10300 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33190-1003
Practice Address - Country:US
Practice Address - Phone:305-253-5100
Practice Address - Fax:305-252-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 251S00000X
FL3928521261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029572801Medicaid
FL029572809Medicaid
FL060303102OtherFLORIDA MEDICAID THERAPEUTIC FOSTER CARE
FL060303101OtherFLORIDA MEDICAID CASE MANAGEMENT
FL053715200Medicaid
FL77026OtherBCBS
FL029572800Medicaid
FL029572810Medicaid
FL029572805Medicaid
FL029572804Medicaid
FL060303100Medicaid
FL101954Medicare Oscar/Certification
FL029572810Medicaid
FL060303100Medicaid
FL029572809Medicaid
FL029572800Medicaid
FL101905Medicare Oscar/Certification
FL101955Medicare Oscar/Certification
FL053715200Medicaid
FL029572805Medicaid
FL77026Medicare ID - Type UnspecifiedPART B
FL101898Medicare Oscar/Certification
101800Medicare Oscar/Certification
FL101953Medicare Oscar/Certification
FL101878Medicare Oscar/Certification