MEDICARE: MELVILLE'S 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1306469481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELVILLE'S BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	424 45TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2924
Country	:	US
Telephone Number	:	401-609-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 N MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-2907
Country	:	US
Telephone Number	:	401-692-3015
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELVIA LOUISE MELVILLE
Credential	:
Telephone Number	:	401-692-3015

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	06/04/2020

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