Organization
COMMUNITY CLUB CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILFREDO RAMIREZ (OWNER)
(000) 000-0000
Entity
Organization
Contact information
Practice address
2650 SW 87TH AVE, MIAMI, FL 33165-2031
(000) 000-0000
Mailing address
2650 SW 87TH AVE, MIAMI, FL 33165-2031
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/02/2024
Last updated
07/04/2024
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