=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891337085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POP BEHAVIORAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 05/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1590 TROPIC PARK DR
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32773-6323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-202-2220
-----------------------------------------------------
Fax | 407-369-4307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1590 TROPIC PARK DR
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32773-6323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-202-2220
-----------------------------------------------------
Fax | 407-369-4307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANA OCANA
-----------------------------------------------------
Credential | CBHCM
-----------------------------------------------------
Telephone | 407-202-2220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------