Provider Demographics
NPI:1811599277
Name:NIRVANA MENTAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:NIRVANA MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MIRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-342-9092
Mailing Address - Street 1:3409 POWERLINE RD STE 1104
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5945
Mailing Address - Country:US
Mailing Address - Phone:561-962-0792
Mailing Address - Fax:561-537-2512
Practice Address - Street 1:3409 POWERLINE RD STE 1104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5945
Practice Address - Country:US
Practice Address - Phone:561-962-0792
Practice Address - Fax:561-537-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health