Provider Demographics
NPI:1447823430
Name:ONE SOUL CMH, INC
Entity type:Organization
Organization Name:ONE SOUL CMH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YULEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-409-4872
Mailing Address - Street 1:5901 NW 183RD ST STE 128
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6009
Mailing Address - Country:US
Mailing Address - Phone:786-409-4872
Mailing Address - Fax:786-360-4270
Practice Address - Street 1:5901 NW 183RD ST STE 128
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6009
Practice Address - Country:US
Practice Address - Phone:786-332-4965
Practice Address - Fax:786-362-6077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE SOUL CMH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-19
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024524700Medicaid
FL024524700Medicaid