MEDICARE: TRIAGE BEHAVIORAL HEALTH AND HUMAN SERVICES, 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1891096624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAGE BEHAVIORAL HEALTH AND HUMAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	1 E BROWARD BLVD
Second Line	:	SUITE 700
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1806
Country	:	US
Telephone Number	:	336-414-7504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E BROWARD BLVD
Second Line	:	SUITE 700
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1806
Country	:	US
Telephone Number	:	336-414-7504
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SHAWN MAURICE THORPE
Credential	:
Telephone Number	:	336-414-7504

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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