MEDICARE: CITRUS HEALTH NETWORK, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154793057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITRUS HEALTH NETWORK, INC.

Provider Business Mailing Address
First Line	:	8400 S PALM DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 S PALM DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33025-4536
Country	:	US
Telephone Number	:	954-342-0355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MARIO JARDON
Credential	:
Telephone Number	:	305-825-0300

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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