# PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson North Community Mental Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063417483
- **Authorized official:** MR. MARK T KNIGHT (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (305) 585-7979

## Contact information

- **Practice address:** 15055 NW 27 AVENUE, OPA-LOCKA, FL 33054-3365
- **Practice address phone:** (305) 466-2800
- **Practice address fax:** (786) 466-2748
- **Mailing address:** P.O. BOX 12493, MIAMI, FL 33101-2493

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 8511 | FL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | 8511 | FL | Yes |
| 261QM0850X | Adult Mental Health Clinic/Center | 8511 | FL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 8511 | FL | — |

## Other

- **Enumeration date:** 06/14/2005
- **Last updated:** 09/04/2020

## 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 |