MEDICARE: COMPREHENSIVE BEHAVIORAL CARE, 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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1225165426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE BEHAVIORAL CARE, INC.

Provider Business Mailing Address
First Line	:	3405 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33607-6207
Country	:	US
Telephone Number	:	813-288-4808
Fax Number	:	813-288-4844

Provider Business Practice Location Address
First Line	:	3405 W DR MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33607-6207
Country	:	US
Telephone Number	:	813-288-4808
Fax Number	:	813-288-4844

Authorized Official
Title or Position	:	CFO
Name	:	MR. ROBERT LANDIS
Credential	:
Telephone Number	:	813-288-4808

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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