Provider Demographics
NPI:1437519055
Name:EBH SERVICES OF FLORIDA
Entity Type:Organization
Organization Name:EBH SERVICES OF FLORIDA
Other - Org Name:LUCIDA TREATMENT CENTER PROF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPLESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHC, CHPC
Authorized Official - Phone:615-510-3708
Mailing Address - Street 1:PO BOX 670521
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-0521
Mailing Address - Country:US
Mailing Address - Phone:615-567-7282
Mailing Address - Fax:
Practice Address - Street 1:112 N OAK ST
Practice Address - Street 2:SUITE 109
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3260
Practice Address - Country:US
Practice Address - Phone:561-337-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID A SACK MD TN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-24
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1109172084P0800X
FLARNP1688752363LP0808X
FLARNP3156662363LP0808X
FLRN9366620364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty