MEDICARE: SAMARITAN HOPE EMPOWERMENT SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center

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

General Provider Information

NPI Number	:	1962085720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN HOPE EMPOWERMENT SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 668055
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33066-8055
Country	:	US
Telephone Number	:	954-994-7685
Fax Number	:	954-206-0697

Provider Business Practice Location Address
First Line	:	1951 W COPANS RD STE 8-14
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-1549
Country	:	US
Telephone Number	:	954-994-7685
Fax Number	:	954-206-0697

Authorized Official
Title or Position	:	CED/DIRECTOR
Name	:	MORIYAH EMUNAH YASHAR'EL
Credential	:
Telephone Number	:	954-994-7685

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	04/29/2021

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