1346287240 NPI number — OSCEOLA MENTAL HEALTH INC

Table of content: (NPI 1346287240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346287240 NPI number — OSCEOLA MENTAL HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSCEOLA MENTAL HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARK PLACE BEHAVIORAL HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346287240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 PARK PLACE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-846-0023
Provider Business Mailing Address Fax Number:
407-483-1064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 PARK PLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-846-0023
Provider Business Practice Location Address Fax Number:
407-483-1064
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARLOW
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT CFO
Authorized Official Telephone Number:
407-846-0023

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 8503 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060313900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10D0870885 . This is a "CLIA NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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