MEDICARE: IBEACON COMMUNITY SERVICES CORP.

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	:	1720515513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBEACON COMMUNITY SERVICES CORP.

Provider Business Mailing Address
First Line	:	571 SW 71ST PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2753
Country	:	US
Telephone Number	:	786-657-1607
Fax Number	:

Provider Business Practice Location Address
First Line	:	571 SW 71ST PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2753
Country	:	US
Telephone Number	:	786-657-1607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NOEL PEDRAZA ALONSO
Credential	:
Telephone Number	:	786-657-1607

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “IBEACON COMMUNITY SERVICES CORP. ” Practice Location

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