Provider Demographics
NPI:1659487965
Name:SOUTH COUNTY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH COUNTY MENTAL HEALTH CENTER
Other - Org Name:SOUTH COUNTY MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-637-1040
Mailing Address - Street 1:16158 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6502
Mailing Address - Country:US
Mailing Address - Phone:561-637-1040
Mailing Address - Fax:561-637-2158
Practice Address - Street 1:16158 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6502
Practice Address - Country:US
Practice Address - Phone:561-637-1040
Practice Address - Fax:561-637-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH7228333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004124OtherPK
FL060276102Medicaid
2004124OtherPK