MEDICARE: C INDIVIDUALS TRANSITION TO WORK

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1891317046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C INDIVIDUALS TRANSITION TO WORK

Provider Business Mailing Address
First Line	:	6378 EMERALD DUNES DR APT 204
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2759
Country	:	US
Telephone Number	:	561-603-0431
Fax Number	:

Provider Business Practice Location Address
First Line	:	6378 EMERALD DUNES DR APT 204
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2759
Country	:	US
Telephone Number	:	561-603-0431
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHERYEL EDNEY
Credential	:
Telephone Number	:	561-603-0431

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	05/11/2020

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