Community Health of South Florida Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Homestead, FL
NPI 1992968408 · NPPES record last updated Apr 17, 2013
Key facts
- NPI
- 1992968408
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH OF SOUTH FLORIDA INC
- Practice address
- 15790 SW 307TH St
Homestead, FL 33033-4200 - Phone
- (305) 245-0270
- Fax
- (305) 247-7903
- NPI assigned
- Jul 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Brodes H Hartley Jr.
- Title
- Ceo
- Phone
- (305) 253-5100
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 12
Practitioners 59
-
Saint Anthony Amofah, M.D.
-
Edwin Bosa-Osorio, M.D.
-
Shaquan Chambliss-Huggins, ARNP, MSN, FNP-C
-
Glenn Cooreman, MD
-
Cindy Cork, O.D.
-
Marcello De Carvalho, MSN, APRN, PMHNP-BC
-
Christopher Edouard, ARNP
-
Alexander J Fernandez, M.D.
-
Gloria Maria Gonzalez, APRN, NP-C
-
Jorge M. Gonzalez, BS, ARNP
-
Lorilee Agatha Graham, APRN
-
Edwin A Herrera, MD
-
Abida Hussain, PA
-
Tariku Menberu, ARNP
-
Yarinel Merencio, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Federally qualified health center certification: CCN 101961
- Legal name
- COMMUNITY HEALTH OF SOUTH FLORIDA INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 10, 2004
- Last certification
- Aug 10, 2004
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 13, 1971 in FL
- Enrollment address
- 15790 SW 307TH Street
Homestead, FL 33030-4200
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Cesar Caicedo |
Corporate Director |
Jan 1, 2015 | |
| Natalie Windsor |
Corporate Director |
Jan 1, 2022 | |
| Paul Herdsman |
Corporate Director |
Jan 1, 2022 | |
| Jeremy Radziewicz |
Corporate Director |
Aug 6, 2019 | |
| Jeffrey Coldren |
Corporate Director |
Jan 1, 2015 | |
| Andre Reid |
Corporate Director |
Jan 1, 2022 | |
| Jose Gancedo |
Corporate Director |
Jan 1, 2022 | |
| Carolyn Taylor-Pates |
Corporate Director |
Jan 1, 2008 | |
| Johnny Brown |
Corporate Director |
Jan 1, 2015 | |
| Carlo Saint Cy |
Corporate Director |
Jan 1, 2022 | |
| Anthony B Hall |
Corporate Director |
Jan 1, 2022 | |
| W-2 Managing Employee |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040719001329 | FL | Part a Provider - Federally Qualified Health Center (FQHC) | 6507770526 | Practice locations: Homestead, FL |
National Provider Directory
- Tax ID family
- Community Health Inc
Locations
15790 SW 307th St
Homestead, FL 33033
Phone (305) 245-0270
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
15790 SW 307TH St
Homestead, FL 33033-4200
Mailing address
10300 SW 216TH St
Miami, FL 33190-1003
Phone (305) 253-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029572821 - FQHC | Medicaid | FL | |
| 029572822 - FFS | Medicaid | FL |
Other names
- Campbell Drive Elementary
Other providers in Homestead, FL
- Community Health of South Florida Inc
- Community Health of South Florida Inc
- Community Health of South Florida Inc
- Community Health of South Florida Inc
- Community Health of South Florida Inc
- Community Health of South Florida, Inc.
- Community Health of South Florida, Inc.
- Community Health of South Florida, Inc.
- Community Health of South Florida, Inc.
- Community Health of South Florida, Inc.
All providers in Homestead, 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 Apr 17, 2013. 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.