MEDICARE: SOUTH COUNTY MENTAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy	PH7228	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004124	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659487965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COUNTY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	16158 S MILITARY TRL
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6502
Country	:	US
Telephone Number	:	561-637-1040
Fax Number	:	561-637-2158

Provider Business Practice Location Address
First Line	:	16158 S MILITARY TRL
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6502
Country	:	US
Telephone Number	:	561-637-1040
Fax Number	:	561-637-2158

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH SPEICHER
Credential	:	RPH
Telephone Number	:	561-637-1040

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/13/2020

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Directions to “SOUTH COUNTY MENTAL HEALTH CENTER ” Practice Location

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