Healthcare Provider Details

I. General information

NPI: 1073374195
Provider Name (Legal Business Name): BEAUTIFUL MINDS SOCIAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 S FLORIDA AVE STE 130
LAKELAND FL
33803-1175
US

IV. Provider business mailing address

1037 S FLORIDA AVE STE 130
LAKELAND FL
33803-1175
US

V. Phone/Fax

Practice location:
  • Phone: 863-450-9308
  • Fax:
Mailing address:
  • Phone: 863-450-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA RAE DAVIS
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential:
Phone: 863-450-9308