Provider Demographics
NPI:1891102224
Name:CARE RESOURCE COMMUNITY HEALTH CENTERS INC
Entity Type:Organization
Organization Name:CARE RESOURCE COMMUNITY HEALTH CENTERS INC
Other - Org Name:CARE RESOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SICLARI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-576-1234
Mailing Address - Street 1:3510 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3840
Mailing Address - Country:US
Mailing Address - Phone:305-576-1234
Mailing Address - Fax:305-571-2020
Practice Address - Street 1:1901 SW 1ST ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:305-571-2020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE RESOURCE COMMUNITY HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-17
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0034079-05Medicaid
FL014305400Medicaid