MEDICARE: CAMILLUS HOUSE, 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	251B00000X	Case Management Agency
2	324500000X	Substance Abuse Rehabilitation Facility	1113AD286202	FL
3	251S00000X	Community/Behavioral Health Agency	13=========04	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447219738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMILLUS HOUSE, INC.

Provider Business Mailing Address
First Line	:	1603 NW 7TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1415
Country	:	US
Telephone Number	:	305-374-1065
Fax Number	:	305-533-2917

Provider Business Practice Location Address
First Line	:	1603 NW 7TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136
Country	:	US
Telephone Number	:	305-374-1065
Fax Number	:	305-533-2917

Authorized Official
Title or Position	:	DIRECTOR OF QUALITY AND OUTCOMES
Name	:	MRS. JAYMEE KENT
Credential	:
Telephone Number	:	305-374-1065

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/14/2024

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Directions to “CAMILLUS HOUSE, INC. ” Practice Location

Language	Start Address	Practice Location

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