| Esp Case Management Professional, Inc | |
|
687 Beville Rd Ste A South Daytona FL 32119-1970 | |
| (386) 760-7533 | |
| (386) 761-5868 |
| Full Name | Esp Case Management Professional, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 687 Beville Rd Ste A, South Daytona, Florida |
| Authorized Official Name and Position | Mary L Fagaragan (PRESIDENT) |
| Authorized Official Contact | 3867607533 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Esp Case Management Professional, Inc 687 Beville Rd Ste A South Daytona FL 32119-1970 Ph: (386) 760-7533 | Esp Case Management Professional, Inc 687 Beville Rd Ste A South Daytona FL 32119-1970 Ph: (386) 760-7533 |
| NPI Number | 1609083476 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 10/10/2023 |
| Certification Date | 10/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609083476 | NPI | - | NPPES |
| 109936300 | Medicaid | FL | |
| 110146900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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