MEDICARE: SALUSCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency	FL
2	251S00000X	Community/Behavioral Health Agency
3	261QC1500X	Community Health Clinic/Center	FL
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	283Q00000X	Psychiatric Hospital
6	284300000X	Special Hospital
7	324500000X	Substance Abuse Rehabilitation Facility
8	3245S0500X	Children's Substance Abuse Rehabilitation Facility
9	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972557197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUSCARE, INC.

Provider Business Mailing Address
First Line	:	3763 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-275-3222
Fax Number	:	239-332-0287

Provider Business Practice Location Address
First Line	:	3763 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-308-1289
Fax Number	:	239-332-0287

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. STACEY COOK
Credential	:	LCSW
Telephone Number	:	239-275-3222

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/19/2023

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Directions to “SALUSCARE, INC. ” Practice Location

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