MEDICARE: MIAMI HOME & COMMUNITY SUPPORT SERVICES INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023108230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI HOME & COMMUNITY SUPPORT SERVICES INC.

Provider Business Mailing Address
First Line	:	7630 SW 137TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3109
Country	:	US
Telephone Number	:	305-386-9946
Fax Number	:	305-386-9946

Provider Business Practice Location Address
First Line	:	7630 SW 137TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3109
Country	:	US
Telephone Number	:	305-386-9946
Fax Number	:	305-386-9946

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARTHA RIVERA
Credential	:	HHA
Telephone Number	:	305-386-9946

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/04/2008

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