=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952926057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FL UNIVERSAL CASE MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2020
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18350 NW 2ND AVE STE 301D
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-4566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-712-1712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18350 NW 2ND AVE STE 301D
-----------------------------------------------------
City | MIAMI GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-4566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-712-1712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MADELEINY GARCIA PUPO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-712-1712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------