Provider Demographics
NPI:1427479724
Name:ASA CENTER LLC
Entity type:Organization
Organization Name:ASA CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-258-4741
Mailing Address - Street 1:9260 HAMMOCKS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1503
Mailing Address - Country:US
Mailing Address - Phone:305-383-2091
Mailing Address - Fax:305-383-2091
Practice Address - Street 1:9260 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1503
Practice Address - Country:US
Practice Address - Phone:305-383-2091
Practice Address - Fax:305-383-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid