Provider Demographics
NPI:1184289639
Name:BLUE MINDS LLC
Entity type:Organization
Organization Name:BLUE MINDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAY
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:786-356-8161
Mailing Address - Street 1:6880 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1171
Mailing Address - Country:US
Mailing Address - Phone:786-356-8161
Mailing Address - Fax:
Practice Address - Street 1:15800 PINES BLVD STE 3011
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1212
Practice Address - Country:US
Practice Address - Phone:786-356-8161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty