MEDICARE: UNIVERSAL COMMUNITY MENTAL CARE 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598930612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL COMMUNITY MENTAL CARE INC

Provider Business Mailing Address
First Line	:	928 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4240
Country	:	US
Telephone Number	:	305-265-5744
Fax Number	:	305-265-5745

Provider Business Practice Location Address
First Line	:	928 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4240
Country	:	US
Telephone Number	:	305-265-5744
Fax Number	:	305-265-5745

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE J RODRIGUEZ
Credential	:
Telephone Number	:	305-265-5744

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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