Provider Demographics
NPI:1801049689
Name:COMMUNITY HEALTH OF SOUTH FL, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH OF SOUTH FL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
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:305-252-4850
Mailing Address - Street 1:13805 SW 264TH ST
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7602
Mailing Address - Country:US
Mailing Address - Phone:305-264-5745
Mailing Address - Fax:
Practice Address - Street 1:13805 SW 264TH ST
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-7602
Practice Address - Country:US
Practice Address - Phone:305-264-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH OF SOUTH FL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH23885261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101897Medicare PIN