MEDICARE: BULWARK BEHAVIORAL HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	177F00000X	Lodging Provider
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548116791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULWARK BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	614 BOBCAT LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-4301
Country	:	US
Telephone Number	:	407-618-9714
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 BOBCAT LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-4301
Country	:	US
Telephone Number	:	407-618-9714
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ALEXANDER F FREEMAN
Credential	:
Telephone Number	:	407-618-9714

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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