Provider Demographics
NPI:1750532123
Name:COMMUNITY E.A.R.S.
Entity type:Organization
Organization Name:COMMUNITY E.A.R.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER, CSC
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PASTORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-725-9785
Mailing Address - Street 1:4320 DEERWOOD LAKE PARKWAY
Mailing Address - Street 2:SUITE 101-307
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-396-5702
Mailing Address - Fax:904-725-9785
Practice Address - Street 1:4320 DEERWOOD LAKE PARKWAY
Practice Address - Street 2:SUITE 101-307
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-396-5702
Practice Address - Fax:904-725-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686732479OtherAHCA
FL687409600OtherDOEA / AHCA
FL686732401Medicaid