MEDICARE: TRAUMA RESOLUTION CENTER

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

General Provider Information

NPI Number	:	1093170128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA RESOLUTION CENTER

Provider Business Mailing Address
First Line	:	900 PERRINE AVE
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5433
Country	:	US
Telephone Number	:	305-374-9990
Fax Number	:	305-374-9995

Provider Business Practice Location Address
First Line	:	900 PERRINE AVE
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5433
Country	:	US
Telephone Number	:	305-374-9990
Fax Number	:	305-374-9995

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERESA DESCILO
Credential	:	MSW
Telephone Number	:	305-374-9990

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/16/2015

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Directions to “TRAUMA RESOLUTION CENTER ” Practice Location

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