Provider Demographics
NPI:1285094813
Name:SOUTHERN WINDS HOSPITAL LLC
Entity type:Organization
Organization Name:SOUTHERN WINDS HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICK-TURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-9700
Mailing Address - Street 1:4225 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5826
Mailing Address - Country:US
Mailing Address - Phone:305-558-9700
Mailing Address - Fax:305-362-5964
Practice Address - Street 1:4225 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5826
Practice Address - Country:US
Practice Address - Phone:305-558-9700
Practice Address - Fax:305-362-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016949600Medicaid