Provider Demographics
NPI:1922491836
Name:MY COMMUNITY CARES, INC.
Entity Type:Organization
Organization Name:MY COMMUNITY CARES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARVIS
Authorized Official - Middle Name:MARLO
Authorized Official - Last Name:WASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-795-8419
Mailing Address - Street 1:1555 N COCOA BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6933
Mailing Address - Country:US
Mailing Address - Phone:321-821-3055
Mailing Address - Fax:321-821-3055
Practice Address - Street 1:1555 N COCOA BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6933
Practice Address - Country:US
Practice Address - Phone:321-821-3055
Practice Address - Fax:321-821-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management