1164851028 NPI number — PROFESSIONAL CASE MANAGEMENT SERVICES CORP

Table of content: (NPI 1164851028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164851028 NPI number — PROFESSIONAL CASE MANAGEMENT SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL CASE MANAGEMENT SERVICES CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164851028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 FONTAINEBLEAU BLVD STE 2J3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-319-7260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 FONTAINEBLEAU BLVD STE 2J3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33172-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-319-7260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-319-7260

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com