MEDICARE: SOFLO BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	2084P0800X	Psychiatry Physician
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215668041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOFLO BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	306 W MANGO ST STE A
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-2835
Country	:	US
Telephone Number	:	954-297-9802
Fax Number	:	561-431-5873

Provider Business Practice Location Address
First Line	:	306 W MANGO ST STE A
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-2835
Country	:	US
Telephone Number	:	954-297-9802
Fax Number	:	561-431-5873

Authorized Official
Title or Position	:	CEO
Name	:	LESLIE G BRAVO
Credential	:
Telephone Number	:	954-297-9802

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	12/31/2025

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