Provider Demographics
NPI:1376328195
Name:MIND-NEURO AND BEHAVIORAL CARE LLC
Entity Type:Organization
Organization Name:MIND-NEURO AND BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELLEGARDE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-272-0201
Mailing Address - Street 1:6238 SAND HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8226
Mailing Address - Country:US
Mailing Address - Phone:407-272-0201
Mailing Address - Fax:
Practice Address - Street 1:6238 SAND HILLS CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-8226
Practice Address - Country:US
Practice Address - Phone:407-272-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty