MEDICARE: EHOME BEHAVIORAL CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	104100000X	Social Worker
4	106H00000X	Marriage & Family Therapist
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1538609003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EHOME BEHAVIORAL CARE

Provider Business Mailing Address
First Line	:	4700 MILLENIA BLVD STE 175
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6015
Country	:	US
Telephone Number	:	833-403-4663
Fax Number	:	888-853-7908

Provider Business Practice Location Address
First Line	:	4700 MILLENIA BLVD STE 175
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6015
Country	:	US
Telephone Number	:	833-403-4663
Fax Number	:	888-853-7908

Authorized Official
Title or Position	:	FOUNDER
Name	:	ROGERS KIRVEN
Credential	:
Telephone Number	:	321-297-8770

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	12/08/2023

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Directions to “EHOME BEHAVIORAL CARE ” Practice Location

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