Provider Demographics
NPI:1598361719
Name:MAGNOLIA COMMUNITY MENTAL HEALTH CENTER LLC
Entity Type:Organization
Organization Name:MAGNOLIA COMMUNITY MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNAMYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALLES CARDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-443-5530
Mailing Address - Street 1:2513 W HILLSBOROUGH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6122
Mailing Address - Country:US
Mailing Address - Phone:813-450-1052
Mailing Address - Fax:813-450-1053
Practice Address - Street 1:2513 W HILLSBOROUGH AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6122
Practice Address - Country:US
Practice Address - Phone:813-450-1052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health