Provider Demographics
NPI:1033593967
Name:BODY & MIND, LLC
Entity Type:Organization
Organization Name:BODY & MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMLET
Authorized Official - Middle Name:R
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-213-3702
Mailing Address - Street 1:4886 LAKE WORTH RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8725
Mailing Address - Country:US
Mailing Address - Phone:954-213-3702
Mailing Address - Fax:
Practice Address - Street 1:4886 LAKE WORTH RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-8725
Practice Address - Country:US
Practice Address - Phone:954-213-3702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty