Provider Demographics
NPI: | 1033167721 |
---|---|
Name: | SOUTH COUNTY MENTAL HEALTH CENTER, INC. |
Entity Type: | Organization |
Organization Name: | SOUTH COUNTY MENTAL HEALTH CENTER, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | SPEICHER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMHC, DPA |
Authorized Official - Phone: | 561-637-1000 |
Mailing Address - Street 1: | 16158 MILITARY TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | DELRAY BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33484-6502 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-637-1000 |
Mailing Address - Fax: | 561-637-1410 |
Practice Address - Street 1: | 16158 MILITARY TRL |
Practice Address - Street 2: | |
Practice Address - City: | DELRAY BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33484 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-637-1000 |
Practice Address - Fax: | 561-637-1410 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2020-06-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 060276101 | 251B00000X |
FL | 060276100 | 261QM0801X, 261QM0850X, 261QM0855X |
FL | 0950AD962202 | 261QR0405X, 320800000X, 323P00000X |
FL | AL10301 | 3104A0625X |
FL | PH6793 | 3336C0003X |
FL | 650409644 | 343900000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 251B00000X | Agencies | Case Management | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 060276100 | Medicaid | |
FL | 060276101 | Medicaid |