Provider Demographics
NPI:1467227926
Name:GEMINI ENTERPRISES LLC
Entity Type:Organization
Organization Name:GEMINI ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:734-846-2642
Mailing Address - Street 1:3105 OAKLAND SHORES DR APT 102J
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5617
Mailing Address - Country:US
Mailing Address - Phone:734-846-2642
Mailing Address - Fax:
Practice Address - Street 1:9101 LAKERIDGE BLVD STE 22
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2180
Practice Address - Country:US
Practice Address - Phone:734-846-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health