Provider Demographics
NPI:1558985366
Name:PSYCHSOURCE
Entity Type:Organization
Organization Name:PSYCHSOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-287-5840
Mailing Address - Street 1:8910 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4100
Mailing Address - Country:US
Mailing Address - Phone:305-919-8099
Mailing Address - Fax:305-919-8119
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:305-919-8099
Practice Address - Fax:305-919-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility