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NPI Code Detail

MEDICARE: CAMILLUS HEALTH CONCERN, INC.

MEDICARE: CAMILLUS HEALTH CONCERN, 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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588829287
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAMILLUS HEALTH CONCERN, INC.
Provider Business Mailing Address
First Line : 336 NW 5TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33128-1616
Country : US
Telephone Number : 305-577-4840
Fax Number : 305-373-7431
Provider Business Practice Location Address
First Line : 800 NW 28TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33127-4046
Country : US
Telephone Number : 305-634-4797
Fax Number : 305-638-8473
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : SHEDRICK BOREN
Credential : PH.D.
Telephone Number : 305-577-4840
Provider Enumeration Date : 07/22/2008
Last Update Date : 07/10/2014

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Directions to “CAMILLUS HEALTH CONCERN, INC. ” Practice Location

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