MEDICARE: COMMUNTI RESOURCES FOR BEHAVIOR HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881329837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNTI RESOURCES FOR BEHAVIOR HEALTH

Provider Business Mailing Address
First Line	:	17438 83RD PL N
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-2613
Country	:	US
Telephone Number	:	678-412-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 ROCK CUT PL
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2104
Country	:	US
Telephone Number	:	678-412-8462
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN/CEO
Name	:	TROY ROLLINS
Credential	:
Telephone Number	:	678-412-8462

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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