Organization
MY CAMPO FELIZ INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAYRA RONDON (PRESIDENT)
(786) 423-7637
Entity
Organization
Contact information
Practice address
856 NW 136TH AVE, MIAMI, FL 33182-2600
(786) 423-7637
(305) 485-0876
Mailing address
856 NW 136TH AVE, MIAMI, FL 33182-2600
(786) 423-7637
(305) 485-0876
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
603042
ATN PROVIDER ENROLLMENT FL MEDICAID
FL
Enumeration date
03/08/2017
Last updated
08/29/2017
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