Organization
GOOD SUPPORT AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIRNA ESTEBANA HERNANDEZ (MANAGER)
(305) 235-2684
Entity
Organization
Contact information
Practice address
14284 SW 176TH TER, MIAMI, FL 33177
(305) 235-2684
(305) 235-6912
Mailing address
14284 SW 176TH TER, MIAMI, FL 33177
(395) 235-2684
(305) 235-6912
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
229223
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682011596
—
FL
05
—
682011598
—
FL
Enumeration date
05/16/2008
Last updated
05/16/2008
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