MEDICARE: PROVIDENCE HEALTH, 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	251S00000X	Community/Behavioral Health Agency	IMT1092	FL

General Provider Information

NPI Number	:	1316285620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH, LLC

Provider Business Mailing Address
First Line	:	43 S POMPANO PKWY
Second Line	:	#305
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3001
Country	:	US
Telephone Number	:	954-857-7430
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 S POMPANO PKWY
Second Line	:	#305
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3001
Country	:	US
Telephone Number	:	954-857-7430
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KAREN FRANCESCHINI
Credential	:	LMFT
Telephone Number	:	954-857-7430

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/21/2013

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