Basic Information
| Provider Information | |||||||||
| NPI: | 1174575708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMPROVING LIVES COMMUNITY MENTAL HEALTH CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7171 SW 62ND AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052705305 | ||||||||
| FaxNumber: | 3052705306 | ||||||||
| Practice Location | |||||||||
| Address1: | 7171 SW 62ND AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052705305 | ||||||||
| FaxNumber: | 3052705306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | ALFREDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3052705305 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S, LMHC | ||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | HCC5151 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.