Provider Demographics
NPI:1972722403
Name:LIGHTHOUSE CMHC OF NORTH DADE
Entity type:Organization
Organization Name:LIGHTHOUSE CMHC OF NORTH DADE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LLAUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-817-5601
Mailing Address - Street 1:1901 NW 7TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3410
Mailing Address - Country:US
Mailing Address - Phone:305-817-5601
Mailing Address - Fax:305-817-5602
Practice Address - Street 1:1901 NW 7TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3410
Practice Address - Country:US
Practice Address - Phone:305-817-5601
Practice Address - Fax:305-817-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6036261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101483Medicare Oscar/Certification