MEDICARE: COMMUNITY HEALTH OF SOUTH DADE 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		FL

General Provider Information

NPI Number	:	1912090713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH OF SOUTH DADE INC.

Provider Business Mailing Address
First Line	:	8820 SOUTH WEST 191 STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157
Country	:	US
Telephone Number	:	305-910-4779
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 SOUTH WEST 181 STREET
Second Line	:	10300 SOUTH WEST 216 STREET
City	:	MIAMI
State	:	FL
Zip	:	33157
Country	:	US
Telephone Number	:	305-254-4968
Fax Number	:

Authorized Official
Title or Position	:	TARGET CASE MANAGER
Name	:	MRS. KATHY L GOLDMAN
Credential	:	BA
Telephone Number	:	305-254-4969

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/22/2020

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