Provider Demographics
NPI:1528664786
Name:SWEET START COMMUNITY WELLNESS CENTER INC
Entity type:Organization
Organization Name:SWEET START COMMUNITY WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-564-5282
Mailing Address - Street 1:5911 NW 173RD DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5122
Mailing Address - Country:US
Mailing Address - Phone:786-876-5198
Mailing Address - Fax:786-907-4140
Practice Address - Street 1:5911 NW 173RD DR STE 5&6
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5121
Practice Address - Country:US
Practice Address - Phone:786-876-5198
Practice Address - Fax:786-907-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112786000Medicaid
0G956OtherMEDICARE
FL108915100Medicaid