MEDICARE: MACTOWN, INC.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	49298	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154518686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACTOWN, INC.

Provider Business Mailing Address
First Line	:	151 NE 62ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-5926
Country	:	US
Telephone Number	:	305-758-4485
Fax Number	:	305-756-9990

Provider Business Practice Location Address
First Line	:	151 NE 62ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-5926
Country	:	US
Telephone Number	:	305-758-4485
Fax Number	:	305-756-9990

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. GABRIEL JOSEPH PEREZ
Credential	:
Telephone Number	:	305-758-4485

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	09/28/2007

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Directions to “MACTOWN, INC. ” Practice Location

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