Provider Demographics
NPI:1891166088
Name:AMARYLLIS MANAGED CARE, LLC
Entity Type:Organization
Organization Name:AMARYLLIS MANAGED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-316-6576
Mailing Address - Street 1:1897 PALM BEACH LAKES BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3508
Mailing Address - Country:US
Mailing Address - Phone:561-814-7505
Mailing Address - Fax:
Practice Address - Street 1:1897 PALM BEACH LAKES BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-814-7505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management