MEDICARE: JACKSON BEHAVIORAL & CASE MANAGEMENT SERVICES

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	:	1821644279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON BEHAVIORAL & CASE MANAGEMENT SERVICES

Provider Business Mailing Address
First Line	:	6300 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-6005
Country	:	US
Telephone Number	:	754-201-8554
Fax Number	:	305-754-4063

Provider Business Practice Location Address
First Line	:	6300 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-6005
Country	:	US
Telephone Number	:	754-201-8554
Fax Number	:	305-754-4063

Authorized Official
Title or Position	:	CEO
Name	:	DAVID ARMAS SR.
Credential	:
Telephone Number	:	754-201-8554

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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