Provider Demographics
NPI:1962016048
Name:PRO COMMUNITY SERVICES CORP
Entity type:Organization
Organization Name:PRO COMMUNITY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-1904
Mailing Address - Street 1:3750 W 16TH AVE STE 138U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4661
Mailing Address - Country:US
Mailing Address - Phone:786-881-0010
Mailing Address - Fax:305-200-5631
Practice Address - Street 1:3750 W 16TH AVE STE 138U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4661
Practice Address - Country:US
Practice Address - Phone:786-881-0010
Practice Address - Fax:305-200-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health