Provider Demographics
NPI:1083606495
Name:CARE RESOURCE COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:CARE RESOURCE COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SICLARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-576-1234
Mailing Address - Street 1:3510 BISCAYNE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3851
Mailing Address - Country:US
Mailing Address - Phone:305-576-1234
Mailing Address - Fax:305-571-2020
Practice Address - Street 1:1680 MICHIGAN AVE STE 912
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QF0400X
FL261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0034079-09Medicaid
FLAH346Medicare PIN
FL25174WMedicare PIN
FL21884OtherFLORIDA BLUE NUMBER
FLU5010YMedicare PIN
F78251Medicare UPIN