Provider Demographics
NPI:1164849931
Name:COMMUNITY CASE MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY CASE MANAGEMENT SERVICES, LLC
Other - Org Name:COMMUNITY RECOVERY AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NADAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-777-3563
Mailing Address - Street 1:815 NW 57TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2042
Mailing Address - Country:US
Mailing Address - Phone:305-777-3563
Mailing Address - Fax:786-703-3424
Practice Address - Street 1:815 NW 57TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:305-777-3563
Practice Address - Fax:786-703-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X, 251S00000X
251B00000X, 261Q00000X, 261QM0801X, 261QM1300X, 261QP2000X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine