Healthcare Provider Details

I. General information

NPI: 1659487965
Provider Name (Legal Business Name): SOUTH COUNTY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16158 S MILITARY TRL
DELRAY BEACH FL
33484-6502
US

IV. Provider business mailing address

16158 S MILITARY TRL
DELRAY BEACH FL
33484-6502
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-1040
  • Fax: 561-637-2158
Mailing address:
  • Phone: 561-637-1040
  • Fax: 561-637-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH7228
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SPEICHER
Title or Position: CEO
Credential: RPH
Phone: 561-637-1040