MEDICARE: CITRUS HEALTH NETWORK

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	:	1417250002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITRUS HEALTH NETWORK

Provider Business Mailing Address
First Line	:	4175 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5874
Country	:	US
Telephone Number	:	305-424-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4216
Country	:	US
Telephone Number	:	305-572-7140
Fax Number	:	305-572-7128

Authorized Official
Title or Position	:	CEO & PRESIDENT
Name	:	MARIO E. JARDON
Credential	:	LCSW
Telephone Number	:	305-424-3100

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	12/21/2010

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Directions to “CITRUS HEALTH NETWORK ” Practice Location

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