MEDICARE: KATHARSIS COMMUNITY MENTAL HEALTH 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

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	:	1295298412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHARSIS COMMUNITY MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	13055 SW 42ND ST STE 205
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3410
Country	:	US
Telephone Number	:	786-970-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	13055 SW 42ND ST STE 205
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3410
Country	:	US
Telephone Number	:	786-970-5033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERASMO M GUERRERO FERNANDEZ
Credential	:
Telephone Number	:	786-970-5033

Provider Enumeration Date	:	04/14/2019
Last Update Date	:	04/14/2019

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