Provider Demographics
NPI:1215502273
Name:JENN MEDICAL CENTER CORP
Entity type:Organization
Organization Name:JENN MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERASMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANAS ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-647-6183
Mailing Address - Street 1:14758 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4067
Mailing Address - Country:US
Mailing Address - Phone:786-647-6183
Mailing Address - Fax:
Practice Address - Street 1:14758 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4067
Practice Address - Country:US
Practice Address - Phone:786-647-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health