Organization
COMMUNITY HEALTH OF SOUTH FLORIDA INC
Active
Other names
CHI-Mobile Medical Unit, CHI Mobile Medical Van
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY DAVID RADZIEWICZ (CFO)
(305) 232-6047
Entity
Organization
Contact information
Practice address
10300 SW 216TH ST, CUTLER BAY, FL 33190-1003
(305) 253-5100
Mailing address
10300 SW 216TH ST, CUTLER BAY, FL 33190-1003
(305) 253-5100
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029572800
—
FL
05
—
060303122
—
FL
05
—
060303124
—
FL
01
—
1336152347
NPI
FL
Enumeration date
05/11/2020
Last updated
08/29/2024
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