Provider Demographics
NPI:1851847834
Name:SENIOR LIVING MEMORY HEALTH, INC.
Entity Type:Organization
Organization Name:SENIOR LIVING MEMORY HEALTH, INC.
Other - Org Name:MEMORY TRAINING CENTERS OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-414-6666
Mailing Address - Street 1:1810 NE 118TH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3311
Mailing Address - Country:US
Mailing Address - Phone:786-414-6666
Mailing Address - Fax:305-456-4124
Practice Address - Street 1:7091 W ATLANTIC AVENUE
Practice Address - Street 2:MTC AT WEISMAN CENTER
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-558-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty