MEDICARE: COMMUNITY RECONSTRUCTION HOUSING CORPORATION, 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

General Provider Information

NPI Number	:	1033680798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RECONSTRUCTION HOUSING CORPORATION, INC.

Provider Business Mailing Address
First Line	:	1100 S STATE ROAD 7 STE 200
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33068-4033
Country	:	US
Telephone Number	:	954-970-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S STATE ROAD 7 STE 200
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33068-4033
Country	:	US
Telephone Number	:	954-970-0006
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. MATHES GUICE
Credential	:
Telephone Number	:	954-857-1436

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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