Provider Demographics
NPI:1053617274
Name:DIRECT HELPERS MEDICAL CENTER INC
Entity type:Organization
Organization Name:DIRECT HELPERS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-3555
Mailing Address - Street 1:5881 NW 151ST ST
Mailing Address - Street 2:115
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2450
Mailing Address - Country:US
Mailing Address - Phone:305-828-3555
Mailing Address - Fax:305-828-3554
Practice Address - Street 1:5881 NW 151ST ST
Practice Address - Street 2:115
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2450
Practice Address - Country:US
Practice Address - Phone:305-828-3555
Practice Address - Fax:305-828-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9011261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 9528OtherAHCA HCC UNIT