MEDICARE: ATHENA HEALTHCARE MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1265744171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENA HEALTHCARE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	2416 N ATLANTIC BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1910
Country	:	US
Telephone Number	:	786-367-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 N ATLANTIC BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1910
Country	:	US
Telephone Number	:	786-367-5480
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAWN STEINBERG
Credential	:
Telephone Number	:	786-367-5480

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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