1629579990 NPI number — BOCA MENTAL HEALTH INC

Table of content: (NPI 1629579990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629579990 NPI number — BOCA MENTAL HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOCA MENTAL HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BOCA MENTAL HEALTH INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629579990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1499 W PALMETTO PARK RD STE 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33486-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-391-4669
Provider Business Mailing Address Fax Number:
561-391-1815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1499 W PALMETTO PARK RD STE 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-391-4669
Provider Business Practice Location Address Fax Number:
561-391-1815
Provider Enumeration Date:
02/22/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AGUILAR DONIS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ELA
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
561-391-4669

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME128950 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)