MEDICARE: ELITE BEHAVIORAL HEALTH CENTER

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1568795615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE BEHAVIORAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	611 NE 13TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1109
Country	:	US
Telephone Number	:	954-563-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 NE 13TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1109
Country	:	US
Telephone Number	:	954-563-8000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENISE SMITH
Credential	:
Telephone Number	:	954-444-6287

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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