Provider Demographics
NPI:1932699188
Name:ORION MENTAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:ORION MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEPE
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:754-263-2050
Mailing Address - Street 1:1460 NW 107TH AVE STE 41N
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2733
Mailing Address - Country:US
Mailing Address - Phone:754-263-2050
Mailing Address - Fax:754-263-2052
Practice Address - Street 1:1460 NW 107TH AVE STE 41N
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2733
Practice Address - Country:US
Practice Address - Phone:754-263-2050
Practice Address - Fax:754-263-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102137200Medicaid
FL106351400Medicaid