Provider Demographics
NPI:1942899240
Name:DIVINE MINDS MYSTIC HEALING CENTER
Entity Type:Organization
Organization Name:DIVINE MINDS MYSTIC HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-857-8479
Mailing Address - Street 1:11 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6430
Mailing Address - Country:US
Mailing Address - Phone:954-857-8479
Mailing Address - Fax:
Practice Address - Street 1:11 PALM AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6430
Practice Address - Country:US
Practice Address - Phone:954-857-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty