Organization
ESP CASE MANAGEMENT PROFESSIONAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY L FAGARAGAN (PRESIDENT)
(386) 760-7533
Entity
Organization
Contact information
Practice address
687 BEVILLE RD STE A, SOUTH DAYTONA, FL 32119-1970
(386) 760-7533
(386) 761-5868
Mailing address
687 BEVILLE RD STE A, SOUTH DAYTONA, FL 32119-1970
(386) 760-7533
(386) 761-5868
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109936300
—
FL
05
—
110146900
—
FL
Enumeration date
05/17/2007
Last updated
10/10/2023
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