Provider Demographics
NPI:1114753761
Name:INNER BALANCE HEALTH CENTER LLC
Entity type:Organization
Organization Name:INNER BALANCE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-222-9194
Mailing Address - Street 1:11125 SW 243RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5148
Mailing Address - Country:US
Mailing Address - Phone:786-209-0023
Mailing Address - Fax:
Practice Address - Street 1:13190 SW 134TH ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4496
Practice Address - Country:US
Practice Address - Phone:786-209-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)