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Organization

PRIDELINES YOUTH SERVICES, INC.

Active
Other names
Pridelines
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EDWARD SUMMERS PH.D. (EXECUTIVE DIRECTOR)
(347) 468-6621
Entity
Organization

Contact information

Practice address
5525 NW 7TH AVE, MIAMI, FL 33127-1401
(305) 571-9601
Mailing address
PO BOX 14340, MIAMI, FL 33101-4340
(305) 571-9601

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
261Q00000X
Clinic/Center
Primary
261QC1500X
Community Health Clinic/Center
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)

Other

Enumeration date
06/01/2024
Last updated
06/05/2024
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