Basic Information
| Provider Information | |||||||||
| NPI: | 1699445775 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5607 NW 27TH AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331422826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058051700 | ||||||||
| FaxNumber: | 3058051715 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 NW 15TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056376400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2021 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | NEASMAN | ||||||||
| AuthorizedOfficialFirstName: | ANNIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3058051700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.