Provider Demographics
NPI:1588961957
Name:HEALING LANDS MEDICAL CENTER INC
Entity type:Organization
Organization Name:HEALING LANDS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-7522
Mailing Address - Street 1:6157 NW 167TH ST
Mailing Address - Street 2:SUITE F-13
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4337
Mailing Address - Country:US
Mailing Address - Phone:305-828-7522
Mailing Address - Fax:305-828-7524
Practice Address - Street 1:6157 NW 167TH ST
Practice Address - Street 2:SUITE F-13
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4337
Practice Address - Country:US
Practice Address - Phone:305-828-7522
Practice Address - Fax:305-828-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8998261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center