Provider Demographics
NPI:1891579538
Name:ELDER LIFE MENTAL HEALTH INC
Entity Type:Organization
Organization Name:ELDER LIFE MENTAL HEALTH INC
Other - Org Name:GUEVARA MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:786-830-4316
Mailing Address - Street 1:18142 SW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5501
Mailing Address - Country:US
Mailing Address - Phone:786-830-4316
Mailing Address - Fax:
Practice Address - Street 1:18142 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5501
Practice Address - Country:US
Practice Address - Phone:786-830-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDER LIFE MENTAL HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty