Healthcare Provider Details

I. General information

NPI: 1801535497
Provider Name (Legal Business Name): COMMUNITY CASE MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 E SOUTH ST STE 500
ORLANDO FL
32801-2986
US

IV. Provider business mailing address

815 NW 57TH AVE STE 400
MIAMI FL
33126-2042
US

V. Phone/Fax

Practice location:
  • Phone: 786-693-6500
  • Fax:
Mailing address:
  • Phone: 786-693-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IGOR NUNEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-325-6219