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NPI Code Detail

MEDICARE: ELLAN DESTINASSE BS, CBHCM

MEDICARE: ELLAN DESTINASSE BS, CBHCM
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
1171M00000XCase Manager/Care CoordinatorCBHCM101948FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750877742
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLAN DESTINASSE BS, CBHCM
Provider Business Mailing Address
First Line : 6750 N ANDREWS AVE STE 200
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33309-2180
Country : US
Telephone Number : 954-258-6017
Fax Number :
Provider Business Practice Location Address
First Line : 6750 N ANDREWS AVE STE 200
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33309-2180
Country : US
Telephone Number : 954-258-6017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 07/03/2018

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