Provider Demographics
NPI:1467004812
Name:THE PEACEFUL MIND FACTORY
Entity Type:Organization
Organization Name:THE PEACEFUL MIND FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LOPEZ MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-663-3983
Mailing Address - Street 1:1165 NW 184TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3633
Mailing Address - Country:US
Mailing Address - Phone:786-663-3983
Mailing Address - Fax:
Practice Address - Street 1:3408 W 84TH ST STE 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4943
Practice Address - Country:US
Practice Address - Phone:786-663-3983
Practice Address - Fax:786-803-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty