Healthcare Provider Details

I. General information

NPI: 1578774824
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CARE MGMT SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 N PINE HILLS RD
ORLANDO FL
32808-3539
US

IV. Provider business mailing address

2917 N PINE HILLS RD
ORLANDO FL
32808-3539
US

V. Phone/Fax

Practice location:
  • Phone: 407-422-0880
  • Fax:
Mailing address:
  • Phone: 407-422-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM L PELLEGRINO
Title or Position: PROGRAM BILLING SPECIALIST
Credential:
Phone: 407-422-0880