MEDICARE: ACSI COMMUNITY BEHAVIORAL CENTER, LLC.

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

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	:	1609383595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACSI COMMUNITY BEHAVIORAL CENTER, LLC.

Provider Business Mailing Address
First Line	:	3113 STIRLING RD STE 204
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6547
Country	:	US
Telephone Number	:	954-842-3501
Fax Number	:	954-206-0906

Provider Business Practice Location Address
First Line	:	3113 STIRLING RD STE 204
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6547
Country	:	US
Telephone Number	:	954-842-3501
Fax Number	:	954-206-0906

Authorized Official
Title or Position	:	CEO
Name	:	MS. YANET RODRIGUEZ
Credential	:	HHA,RPT,MA
Telephone Number	:	954-842-3501

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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