Healthcare Provider Details

I. General information

NPI: 1891337085
Provider Name (Legal Business Name): POP BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 TROPIC PARK DR
SANFORD FL
32773-6323
US

IV. Provider business mailing address

1590 TROPIC PARK DR
SANFORD FL
32773-6323
US

V. Phone/Fax

Practice location:
  • Phone: 407-202-2220
  • Fax: 407-369-4307
Mailing address:
  • Phone: 407-202-2220
  • Fax: 407-369-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANA OCANA
Title or Position: PRESIDENT
Credential: CBHCM
Phone: 407-202-2220