MEDICARE: 11911 PINE FOREST DRIVE, NEW PORT RITCHEY 34654

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1912532441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	11911 PINE FOREST DRIVE, NEW PORT RITCHEY 34654

Provider Business Mailing Address
First Line	:	10144 ARBOR RUN DR UNIT 28
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3568
Country	:	US
Telephone Number	:	813-526-4155
Fax Number	:

Provider Business Practice Location Address
First Line	:	11911 PINE FOREST DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-1462
Country	:	US
Telephone Number	:	813-526-4155
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MS. NEVEH MAHILUM
Credential	:
Telephone Number	:	813-526-4155

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/16/2020

Similar Medicare Providers

1215486071 — DIVINE HERITAGE, LLC
Practice Location Address:

11911 PINE FOREST DR
NEW PORT RICHEY, FL
34654-1462

Practice Phone: 813-317-7991
Practice Fax:

1881277879 — ARGELIS ALVAYERO
Practice Location Address:

185 MANORHAVEN BLVD APT W2
PORT WASHINGTON, NY
11050-1462

Practice Phone: 516-451-6222
Practice Fax:

1639979222 — STEPHANIE EWANCIW
Practice Location Address:

1462 US HIGHWAY 6
PORT JERVIS, NY
12771-3473

Practice Phone: 845-517-8026
Practice Fax:

1033346895 — MS. MARTHA HOSANG LCSW
Practice Location Address:

609 COLUMBUS AVE. , 16H
NEW YORK, NY
10024-1462

Practice Phone: 917-445-6260
Practice Fax:

1942647763 — DARCY MARIE ABRAMS MS CCC-SLP
Practice Location Address:

1462 1ST AVE , APT 4W
NEW YORK, NY
10075-2244

Practice Phone: 315-272-6902
Practice Fax:

1154708311 — MISS BRIELLE NICOLE HASSA MS OTR/L
Practice Location Address:

679 WILLIAM BLISS DR
NEW MILFORD, NJ
07646-1462

Practice Phone: 201-638-6596
Practice Fax:

Directions to “11911 PINE FOREST DRIVE, NEW PORT RITCHEY 34654 ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.