MEDICARE: ELLEORHIM MENTAL WELLBEING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LF0000X	Family Nurse Practitioner
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1417406026	OTHER	FL	1417406026
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013670025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEORHIM MENTAL WELLBEING LLC

Provider Business Mailing Address
First Line	:	20523 NW 8TH AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-2381
Country	:	US
Telephone Number	:	786-223-1744
Fax Number	:

Provider Business Practice Location Address
First Line	:	6115 STIRLING RD STE 215
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7240
Country	:	US
Telephone Number	:	178-622-3174
Fax Number	:	786-930-4046

Authorized Official
Title or Position	:	PMHNP
Name	:	MRS. MARIE CARLINE OSEH
Credential	:	APRN
Telephone Number	:	786-223-1744

Provider Enumeration Date	:	10/17/2021
Last Update Date	:	08/30/2024

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Directions to “ELLEORHIM MENTAL WELLBEING LLC ” Practice Location

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