MEDICARE: INVESTING IN BEHAVIORAL SERVICES INTERNATIONAL

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1326312588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVESTING IN BEHAVIORAL SERVICES INTERNATIONAL

Provider Business Mailing Address
First Line	:	199 CESAR CHAVEZ ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	199 CESAR CHAVEZ ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-2309
Country	:	US
Telephone Number	:	310-430-9473
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARCO AURELIO PLASENCIA
Credential	:
Telephone Number	:	310-430-9473

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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