MEDICARE: M B BEHAVIORAL HEALTH SERVICES-LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1013449495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M B BEHAVIORAL HEALTH SERVICES-LLC

Provider Business Mailing Address
First Line	:	PO BOX 26121
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33320-6121
Country	:	US
Telephone Number	:	954-601-6078
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 NW 24TH CT APT C215
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-2663
Country	:	US
Telephone Number	:	954-601-6078
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS MARIE G BATEAU
Credential	:
Telephone Number	:	954-601-6078

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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