MEDICARE: BEHAVIORAL HEALTH OF ROCHESTER, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	6801093319	MI
2	251S00000X	Community/Behavioral Health Agency	6801093319	MI

General Provider Information

NPI Number	:	1760807671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH OF ROCHESTER, LLC

Provider Business Mailing Address
First Line	:	1344 CHESTNUT CIR
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48309-1714
Country	:	US
Telephone Number	:	248-891-0991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 CHESTNUT CIR
Second Line	:
City	:	ROCHESTER HLS
State	:	MI
Zip	:	48309-1714
Country	:	US
Telephone Number	:	248-891-0991
Fax Number	:

Authorized Official
Title or Position	:	OWNER; SOCIAL WORKER
Name	:	MS. KAREN R FARRAR
Credential	:	LMSW
Telephone Number	:	248-891-0991

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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