MEDICARE: COMMUNITY ACTION BRIDGE 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1790383933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ACTION BRIDGE INC

Provider Business Mailing Address
First Line	:	1840 W 49TH ST STE 739
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2824
Country	:	US
Telephone Number	:	786-955-3821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W 49TH ST STE 739
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2824
Country	:	US
Telephone Number	:	786-955-3821
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEANDRO NAJARRO SOCA
Credential	:
Telephone Number	:	786-955-3821

Provider Enumeration Date	:	10/10/2020
Last Update Date	:	10/10/2020

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