MEDICARE: ORIGINS BEHAVIORAL HEALTHCARE OF FLORIDA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	323P00000X	Psychiatric Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1487050068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORIGINS BEHAVIORAL HEALTHCARE OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	933 45TH ST
Second Line	:
City	:	MANGONIA PARK
State	:	FL
Zip	:	33407-2413
Country	:	US
Telephone Number	:	561-841-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 EAST AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2374
Country	:	US
Telephone Number	:	561-841-1000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JENNIFER LEE
Credential	:
Telephone Number	:	561-841-1003

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	05/02/2024

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