=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740748615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE DIMENSIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2019
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9999 NE 2ND AVE
-----------------------------------------------------
City | MIAMI SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-306-3805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9999 NE 2ND AVE
-----------------------------------------------------
City | MIAMI SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33138-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-306-3805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | WILFREDO MORALES GONZALEZ
-----------------------------------------------------
Credential | CBHCMS
-----------------------------------------------------
Telephone | 786-306-3805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------