Provider Demographics
NPI:1336569821
Name:PROMISE HOSPITAL OF DADE, INC.
Entity Type:Organization
Organization Name:PROMISE HOSPITAL OF DADE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-869-3100
Mailing Address - Street 1:999 YAMATO RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4477
Mailing Address - Country:US
Mailing Address - Phone:561-869-3100
Mailing Address - Fax:561-869-3104
Practice Address - Street 1:14001 NW 82ND AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:561-869-3100
Practice Address - Fax:561-869-3104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMISE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-23
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
102031Medicare Oscar/Certification