Provider Demographics
NPI:1346837812
Name:BALANCED MIND INTEGRATIVE CARE, LLC
Entity Type:Organization
Organization Name:BALANCED MIND INTEGRATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:GENA
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-295-7116
Mailing Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6933
Mailing Address - Country:US
Mailing Address - Phone:954-295-7116
Mailing Address - Fax:
Practice Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6933
Practice Address - Country:US
Practice Address - Phone:954-367-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty