Provider Demographics
NPI:1154891422
Name:THE UNITED STATES FIRE DEPARTMENT RESERVE CORPS, INC.
Entity type:Organization
Organization Name:THE UNITED STATES FIRE DEPARTMENT RESERVE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NCMDR
Authorized Official - Prefix:
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-332-7100
Mailing Address - Street 1:4700 MILLENIA BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6015
Mailing Address - Country:US
Mailing Address - Phone:132-133-2710
Mailing Address - Fax:866-493-0920
Practice Address - Street 1:4700 MILLENIA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6015
Practice Address - Country:US
Practice Address - Phone:132-133-2710
Practice Address - Fax:866-493-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1060527OtherBEACON HEALTH OPTIONS
FL104797200Medicaid
FL101541400Medicaid
FLM5945OtherFIRST COST SERVICES OPTIONS
FL161242OtherWELLCARE