Healthcare Provider Details

I. General information

NPI: 1841790920
Provider Name (Legal Business Name): HEART AND MIND HEALING CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8399 W OAKLAND PARK BLVD STE A
SUNRISE FL
33351-7311
US

IV. Provider business mailing address

8399 W OAKLAND PARK BLVD STE A
SUNRISE FL
33351-7311
US

V. Phone/Fax

Practice location:
  • Phone: 772-418-1156
  • Fax: 561-404-1425
Mailing address:
  • Phone: 772-418-1156
  • Fax: 561-404-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. AYINDE REID
Title or Position: PRESIDENT
Credential: L.C.S.W.
Phone: 561-404-1422