Provider Demographics
NPI:1689191579
Name:COMMUNITY MENTAL HEALTH AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH AND WELLNESS CENTER INC
Other - Org Name:COMMUNITY MENTAL HEALTH AND WELLNESS CENTER OF DORAL INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-556-1397
Mailing Address - Street 1:9300 NW 25TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1506
Mailing Address - Country:US
Mailing Address - Phone:786-320-7602
Mailing Address - Fax:
Practice Address - Street 1:9300 NW 25TH ST STE 106
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1506
Practice Address - Country:US
Practice Address - Phone:786-320-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC11306OtherAHCA