MEDICARE: COMPREHENSIVE HEALTHCARE INITIATIVE

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
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1295008977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE HEALTHCARE INITIATIVE

Provider Business Mailing Address
First Line	:	4805 RIVER POINT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 RIVER POINT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2117
Country	:	US
Telephone Number	:	919-491-6896
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHINYERE ACHOLONU
Credential	:
Telephone Number	:	919-491-6896

Provider Enumeration Date	:	02/11/2012
Last Update Date	:	02/11/2012

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