Provider Demographics
NPI:1376217588
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:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-637-1028
Mailing Address - Street 1:16158 S 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:561-637-1028
Mailing Address - Fax:
Practice Address - Street 1:808 NW AVENUE D
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2904
Practice Address - Country:US
Practice Address - Phone:561-708-8396
Practice Address - Fax:561-983-8583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COUNTY MENTAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060276114Medicaid