MEDICARE: SERVICE WORLD COMMUNITY CORP.

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003323825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICE WORLD COMMUNITY CORP.

Provider Business Mailing Address
First Line	:	1720 HARRISON ST STE 5A-2
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6829
Country	:	US
Telephone Number	:	786-326-3998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 HARRISON ST STE 5A-2
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6829
Country	:	US
Telephone Number	:	786-326-3998
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LUIS GASCA DIAZ
Credential	:
Telephone Number	:	786-326-3998

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	03/17/2020

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