MEDICARE: JUST IN TIME COMMUNITY CASE MANAGEMENT SERVICES LLC

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	:	1275376352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST IN TIME COMMUNITY CASE MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	2151 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	216-713-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W 81ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4162
Country	:	US
Telephone Number	:	216-713-3831
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. JUSTIN O MACK
Credential	:	BA, QMHS, CDCA
Telephone Number	:	216-713-3831

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	07/15/2024

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