MEDICARE: CHILDREN ADULT SERVICE AGENCY, 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	251B00000X	Case Management Agency		FL

General Provider Information

NPI Number	:	1366826869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN ADULT SERVICE AGENCY, INC.

Provider Business Mailing Address
First Line	:	9620 SW 48 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	305-796-1618
Fax Number	:

Provider Business Practice Location Address
First Line	:	9620 SW 48 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	305-796-1618
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PEDRO ACEVEDO
Credential	:
Telephone Number	:	305-796-1618

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/28/2015

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