Healthcare Provider Details

I. General information

NPI: 1295105823
Provider Name (Legal Business Name): MHEALTHCARE CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 VALENCIA RD
JACKSONVILLE FL
32205-9271
US

IV. Provider business mailing address

3805 VALENCIA RD
JACKSONVILLE FL
32205-9271
US

V. Phone/Fax

Practice location:
  • Phone: 732-668-3488
  • Fax: 888-972-6788
Mailing address:
  • Phone: 732-668-3488
  • Fax: 888-972-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RALPH MAY
Title or Position: PRESIDENT
Credential:
Phone: 732-668-3488