NPI |
1649868175 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
COMPREHENSIVE CARE ADVANTAGE INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
CCA |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
5 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
13899 BISCAYNE BLVD STE 141 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
NORTH MIAMI BEACH |
Other last name by which the provider being identified is or has been known. |
Provider Business Practice Location Address State Name |
FL |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
331811650 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3058969754 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address Fax Number |
7869166887 |
The city name in the location address of the provider being identified. |
Provider Enumeration Date |
1/10/2021 |
The State code in the location of the provider
being identified. |
Last Update Date |
2/22/2021 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Authorized Official Last Name |
CORDIA |
The country code in the location address of the provider being identified. |
Authorized Official First Name |
JOHN |
The first name of the authorized official. |
Authorized Official Middle Name |
ODIA |
The middle name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT/CEO |
The date that a record was last updated or changed. |
Authorized Official Telephone Number |
7542045864 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
364SP0808X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
Authorized Official Credential Text |
PMHNP-BC |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|
NPI Certification Date |
2/22/2021 |
|