Citrus Health Network Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hialeah, FL
NPI 1275647752 · NPPES record last updated Nov 3, 2014
Key facts
- NPI
- 1275647752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 744441 (FL)
- Legal business name
- CITRUS HEALTH NETWORK INC
- Practice address
- 4175 W 20TH Ave
Hialeah, FL 33012-5874 - Phone
- (305) 558-0151
- Fax
- (305) 818-1885
- NPI assigned
- Aug 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Mario Jardon
- Title
- Ceo
- Phone
- (305) 558-0151
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 25
Practitioners 65
-
Ixsa T. Garcia-Juarbe, D.O, D.P.M
-
Omar D Suarez, MD
-
Jose Humberto Pagliery, M.D.
-
Maria V. Alonso, LMFT
-
Xenia Aponte, M.D.
-
Ana Maria Archilla, LMHC
-
Biviana Maria Arroyave, APRN
-
Mercy Blanco, MD
-
Laura Cabrera, LCSW
-
Madelyn Cabrera, PSY.D.
-
Jose H Caraballo, LCSW
-
Marcos Enrique Cintron, M.D.
-
Wardy Maria Conde, LMHC
-
Nardelis Cuevas, MS
-
Joanna Garcia, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Federally qualified health center certification: CCN 101970
- Legal name
- CITRUS HEALTH NETWORK, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 13, 2005
- Last certification
- May 13, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 2, 1978 in FL
- Enrollment address
- 4175W 20TH Ave
Hialeah, FL 33012-5874
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Gil Lopez |
Corporate Director |
Oct 1, 2005 | |
| Caridad Castro |
Corporate Director |
Oct 1, 1993 | |
| Alicia Arner |
Corporate Director |
Sep 27, 2016 | |
| Sanford Bohrer |
Corporate Director |
May 28, 2019 | |
| Mario Jardon |
Corporate Officer |
Sep 1, 1979 | |
| W-2 Managing Employee |
Oct 1, 1980 | ||
| Tyrone Coverson |
Corporate Director |
Oct 1, 1999 | |
| Maria Alonso |
Corporate Officer |
Mar 16, 1981 | |
| W-2 Managing Employee |
Jul 21, 2010 | ||
| Jose Delcueto |
Corporate Director |
Oct 22, 2019 | |
| Karin F Esposito |
Corporate Director |
May 28, 2019 | |
| Pauline Clark-Trotman |
Corporate Director |
Apr 27, 2018 | |
| Georgina Cortes Suarez |
Corporate Director |
Oct 1, 2006 | |
| Patricia Croysdale |
Corporate Director |
Oct 1, 1995 | |
| Fernando Franco |
Corporate Director |
Jun 17, 2014 | |
| Maria Teresa Sanjuan |
Corporate Director |
Oct 1, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040923000283 | FL | Part B Supplier - Clinic/Group Practice | 9931177334 |
Receives reassigned benefits from 117 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Hialeah, FL; Miami, FL |
| O20100923000626 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 9931177334 | Practice locations: Hialeah, FL |
National Provider Directory
- Tax ID family
- Citrus Health Network Inc
Locations
802 S Dixie Hwy
Lake Worth, FL 33460
2315 W Flagler St
Miami, FL 33135
Phone (786) 517-4888
8765 SW 165th Ave
Miami, FL 33193
Phone (305) 728-0605
8765 SW 165th Ave
Ste 110114
Miami, FL 33193
Phone (786) 209-2160
8765 SW 165th Ave
Ste 114
Miami, FL 33193
Networks
- HealthSun Health Plans Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 744441 | FL | Yes |
Addresses
Primary practice location
4175 W 20TH Ave
Hialeah, FL 33012-5874
Mailing address
4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone (305) 558-0151
Other providers in Hialeah, FL
- Citrus Health Network
- Citrus Health Network
- Citrus Health Network Inc
- Citrus Health Network Inc
- Citrus Health Network Inc
- Citrus Health Network Inc
- Citrus Health Network Inc
- Citrus Health Network-Rits
- Citrus Health Network, Inc
- Citrus Health Network, Inc
All providers in Hialeah, FL · Federally Qualified Health Center (FQHC) in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.