MEDICARE: QUALIC HEALTH 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

General Provider Information

NPI Number	:	1619446895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALIC HEALTH LLC

Provider Business Mailing Address
First Line	:	870 GAZETTA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 GAZETTA WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1059
Country	:	US
Telephone Number	:	561-568-5440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC CHIYEMBEKEZA
Credential	:
Telephone Number	:	561-568-5440

Provider Enumeration Date	:	11/17/2018
Last Update Date	:	11/17/2018

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Directions to “QUALIC HEALTH LLC ” Practice Location

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