Provider Demographics
NPI:1043880909
Name:MENTAL HEALTH RESOURCE CENTER INC
Entity Type:Organization
Organization Name:MENTAL HEALTH RESOURCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-743-1883
Mailing Address - Street 1:PO BOX 19249
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9249
Mailing Address - Country:US
Mailing Address - Phone:904-743-1883
Mailing Address - Fax:904-743-5309
Practice Address - Street 1:500 BARTON BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3172
Practice Address - Country:US
Practice Address - Phone:321-504-3888
Practice Address - Fax:321-504-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99464OtherMEDICARE