MEDICARE: AMELLO CASE MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	238538	FL

General Provider Information

NPI Number	:	1023317369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMELLO CASE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	7028 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7028 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2292
Country	:	US
Telephone Number	:	813-489-5084
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERTA WARREN
Credential	:
Telephone Number	:	813-489-5084

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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