Provider Demographics
NPI:1588074306
Name:JEWISH COMMUNITY SERVICES OF SOUTH FLORIDA, INC.
Entity type:Organization
Organization Name:JEWISH COMMUNITY SERVICES OF SOUTH FLORIDA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIXTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-403-6513
Mailing Address - Street 1:7875 SW 104TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2642
Mailing Address - Country:US
Mailing Address - Phone:305-670-1911
Mailing Address - Fax:305-670-2049
Practice Address - Street 1:610 ESPANOLA WAY
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3969
Practice Address - Country:US
Practice Address - Phone:305-673-6060
Practice Address - Fax:305-673-2522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH COMMUNITY SERVICES OF SOUTH FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-01
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681521900Medicaid