Provider Demographics
NPI:1396101697
Name:NEUMIND WELLNESS GROUP LLC
Entity type:Organization
Organization Name:NEUMIND WELLNESS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-394-0573
Mailing Address - Street 1:2113 RUBY RED BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6115
Mailing Address - Country:US
Mailing Address - Phone:352-394-0573
Mailing Address - Fax:
Practice Address - Street 1:2113 RUBY RED BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6115
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health