Provider Demographics
NPI:1336199447
Name:MEDI NURSE BEHAVIORAL SOLUTIONS INC
Entity Type:Organization
Organization Name:MEDI NURSE BEHAVIORAL SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRECSEK
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMHC
Authorized Official - Phone:954-484-0051
Mailing Address - Street 1:2800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1370
Mailing Address - Country:US
Mailing Address - Phone:954-484-0051
Mailing Address - Fax:954-485-4452
Practice Address - Street 1:6175 NW 167TH ST
Practice Address - Street 2:SUITE G-15
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-4339
Practice Address - Country:US
Practice Address - Phone:305-824-8880
Practice Address - Fax:954-485-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209943OtherAMERIGROUP PROVIDER NUM