Provider Demographics
NPI:1336583004
Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
Other - Org Name:SOUTH MIAMI HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-252-4853
Mailing Address - Street 1:10300 SW 216TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1003
Mailing Address - Country:US
Mailing Address - Phone:305-253-5100
Mailing Address - Fax:305-252-5881
Practice Address - Street 1:6350 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4836
Practice Address - Country:US
Practice Address - Phone:305-253-5100
Practice Address - Fax:305-252-5811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FQHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1309251S00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029572877Medicaid
FL029572875Medicaid
FL060303115Medicaid
FL060303115Medicaid