Provider Demographics
NPI:1417019357
Name:MENTAL WELLNESS CENTER
Entity Type:Organization
Organization Name:MENTAL WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOFSKY
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:305-442-9020
Mailing Address - Street 1:1735 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3501
Mailing Address - Country:US
Mailing Address - Phone:305-442-9020
Mailing Address - Fax:305-442-8284
Practice Address - Street 1:1735 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3501
Practice Address - Country:US
Practice Address - Phone:305-442-9020
Practice Address - Fax:305-442-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health