Healthcare Provider Details

I. General information

NPI: 1598361719
Provider Name (Legal Business Name): MAGNOLIA COMMUNITY MENTAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 W HILLSBOROUGH AVE STE 210
TAMPA FL
33614-6122
US

IV. Provider business mailing address

2513 W HILLSBOROUGH AVE STE 210
TAMPA FL
33614-6122
US

V. Phone/Fax

Practice location:
  • Phone: 813-450-1052
  • Fax:
Mailing address:
  • Phone: 813-450-1052
  • Fax: 813-450-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SUNAMYS MIRALLES CARDET
Title or Position: OWNER
Credential:
Phone: 813-443-5530