MEDICARE: UP FRONT, 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	251S00000X	Community/Behavioral Health Agency	1113AD859501	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1113AD859501	OTHER	FL	LEVEL 1 SUBSTANCE ABUSE P

General Provider Information

NPI Number	:	1457541203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UP FRONT, INC.

Provider Business Mailing Address
First Line	:	13287 SW 124TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6437
Country	:	US
Telephone Number	:	786-242-8222
Fax Number	:	786-242-8759

Provider Business Practice Location Address
First Line	:	13287 SW 124TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6437
Country	:	US
Telephone Number	:	786-242-8222
Fax Number	:	786-242-8759

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES NICHOLSON HALL
Credential	:
Telephone Number	:	786-242-8222

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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Directions to “UP FRONT, INC. ” Practice Location

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