Provider Demographics
NPI:1346287240
Name:OSCEOLA MENTAL HEALTH INC
Entity Type:Organization
Organization Name:OSCEOLA MENTAL HEALTH INC
Other - Org Name:PARK PLACE BEHAVIORAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-846-0023
Mailing Address - Street 1:206 PARK PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2344
Mailing Address - Country:US
Mailing Address - Phone:407-846-0023
Mailing Address - Fax:407-483-1064
Practice Address - Street 1:206 PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2344
Practice Address - Country:US
Practice Address - Phone:407-846-0023
Practice Address - Fax:407-483-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251S00000X, 320800000X
FL8503261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060313900Medicaid
FL10D0870885OtherCLIA NUMBER
FL101485Medicare Oscar/Certification
FL10D0870885OtherCLIA NUMBER