Healthcare Provider Details

I. General information

NPI: 1477911642
Provider Name (Legal Business Name): EBH ACQUISITION SUBSIDIARY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E COMMERCIAL BLVD
FT LAUDERDALE FL
33308-4327
US

IV. Provider business mailing address

PO BOX 670556
DALLAS TX
75267-0556
US

V. Phone/Fax

Practice location:
  • Phone: 615-567-7256
  • Fax:
Mailing address:
  • Phone: 615-567-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME77726
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME96991
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARPN1952242
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9199231
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP2857482
License Number StateFL

VIII. Authorized Official

Name: MS. CHERYK MAPLESDEN
Title or Position: DIRECTOR, REVENUE CYCLE
Credential: CPC, CHC, CHPC
Phone: 615-510-3708