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Organization
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Active
Organization
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Active
Other names
Jackson North Community Mental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK T KNIGHT (CHIEF FINANCIAL OFFICER)
(305) 585-7979
Entity
Organization
Contact information
Practice address
15055 NW 27 AVENUE, OPA-LOCKA, FL 33054-3365
(305) 466-2800
(786) 466-2748
Mailing address
P.O. BOX 12493, MIAMI, FL 33101-2493
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
8511
FL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
8511
FL
261QM0850X
Adult Mental Health Clinic/Center
8511
FL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
8511
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005851600
—
FL
05
—
014357500
—
FL
05
—
075501000
—
FL
01
—
142202200
ASSISTED CARE SERVICES
FL
05
—
686226896
—
FL
05
—
912237100
—
FL
05
—
912301600
—
FL
Enumeration date
06/14/2005
Last updated
09/04/2020
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