MEDICARE: PSYCHE COMMUNITY 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	273R00000X	Psychiatric Hospital Unit	HCC6703	FL

General Provider Information

NPI Number	:	1891742524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHE COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	4851 NW 183RD ST
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	305-622-2850
Fax Number	:	305-622-2852

Provider Business Practice Location Address
First Line	:	4851 NW 183RD ST
Second Line	:
City	:	OPA LOCKA
State	:	FL
Zip	:	33055-2955
Country	:	US
Telephone Number	:	305-622-2850
Fax Number	:	305-622-2852

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	FELIX PAGES
Credential	:
Telephone Number	:	305-622-2850

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

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