Provider Demographics
NPI:1841790920
Name:HEART AND MIND HEALING CENTER CORP
Entity Type:Organization
Organization Name:HEART AND MIND HEALING CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AYINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-404-1422
Mailing Address - Street 1:8399 W OAKLAND PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7311
Mailing Address - Country:US
Mailing Address - Phone:772-418-1156
Mailing Address - Fax:561-404-1425
Practice Address - Street 1:8399 W OAKLAND PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7311
Practice Address - Country:US
Practice Address - Phone:772-418-1156
Practice Address - Fax:561-404-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251B00000XAgenciesCase Management
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104898OtherCOMMUNITY OUTPATIENT REHABILITATION FACILITY
FL82Medicaid