Provider Demographics
NPI:1356180723
Name:RESILIENT MIND PSYCHIATRY & WELLNESS LLC
Entity type:Organization
Organization Name:RESILIENT MIND PSYCHIATRY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:DAILE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-371-4491
Mailing Address - Street 1:1910 NW 78TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0910
Mailing Address - Country:US
Mailing Address - Phone:786-371-4491
Mailing Address - Fax:
Practice Address - Street 1:1910 NW 78TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-0910
Practice Address - Country:US
Practice Address - Phone:786-371-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty