MEDICARE: ADVANCED CARE PROFESSIONAL,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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

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	:	1770864555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE PROFESSIONAL,INC

Provider Business Mailing Address
First Line	:	4633 SW 13TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2730
Country	:	US
Telephone Number	:	786-837-1271
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 SW 13TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2730
Country	:	US
Telephone Number	:	786-837-1271
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIDELNIS PEREIRA
Credential	:
Telephone Number	:	786-837-1271

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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