Provider Demographics
NPI:1861697138
Name:CHARLEE OF DADE COUNTY
Entity type:Organization
Organization Name:CHARLEE OF DADE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-779-9641
Mailing Address - Street 1:155 SOUTH MIAMI AVE.
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130
Mailing Address - Country:US
Mailing Address - Phone:305-779-9600
Mailing Address - Fax:305-779-9608
Practice Address - Street 1:155 SOUTH MIAMI AVE.
Practice Address - Street 2:SUITE 700
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:305-779-9600
Practice Address - Fax:305-779-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHA 1106 3239 89251B00000X
251B00000X
FLSW7462251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL751433601Medicaid
FL751433600Medicaid