Organization
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Active
Other names
Jessie Trice Community Health Center Inc, Florida Memorial University Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN R HAWKINS (PRESIDENT AND CEO)
(305) 805-1700
Entity
Organization
Contact information
Practice address
15800 NW 42ND AVE, MIAMI GARDENS, FL 33054-6155
(305) 637-6400
(305) 636-5155
Mailing address
5607 NW 27TH AVE, STE 1, MIAMI, FL 33142-2826
(305) 805-1700
(305) 805-1715
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029542600
—
FL
05
—
029542601
—
FL
Enumeration date
06/25/2008
Last updated
11/26/2024
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