MEDICARE: DESTINATION HOPE

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	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility	1706AD588401	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1045136	OTHER	FL	DCF IOP
2	1045135	OTHER	FL	DCF OP
3	1045134	OTHER	FL	DCF D/N LIC

General Provider Information

NPI Number	:	1811192214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTINATION HOPE

Provider Business Mailing Address
First Line	:	6460 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	954-771-2091
Fax Number	:	954-771-2098

Provider Business Practice Location Address
First Line	:	6460 NW 5TH WAY
Second Line	:	SUITES 6458, 6456, 6454
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	954-771-2091
Fax Number	:	954-771-2098

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BENJAMIN B BRAFMAN
Credential	:	L.M.H.C.
Telephone Number	:	954-771-2091

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/21/2022

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Directions to “DESTINATION HOPE ” Practice Location

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