MEDICARE: OSCEOLA MENTAL HEALTH INC

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	251B00000X	Case Management Agency		FL
2	320800000X	Mental Illness Community Based Residential Treatment Facility		FL
3	251S00000X	Community/Behavioral Health Agency		FL
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	8503	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10D0870885	OTHER	FL	CLIA NUMBER

General Provider Information

NPI Number	:	1346287240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSCEOLA MENTAL HEALTH INC

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

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

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/15/2013

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Directions to “OSCEOLA MENTAL HEALTH INC ” Practice Location

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