MEDICARE: COMMON SENSE CHILD BIRTH 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	5694	FM
2	251E00000X	Home Health Agency		FL
3	101Y00000X	Counselor		FL

General Provider Information

NPI Number	:	1184015596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMON SENSE CHILD BIRTH INC

Provider Business Mailing Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE #340
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3522
Country	:	US
Telephone Number	:	407-656-6938
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE #340
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3522
Country	:	US
Telephone Number	:	407-656-6938
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JENNIE JOSEPH
Credential	:	CPM
Telephone Number	:	407-656-6938

Provider Enumeration Date	:	02/08/2015
Last Update Date	:	02/08/2015

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