Healthcare Provider Details

I. General information

NPI: 1831967603
Provider Name (Legal Business Name): COMPLETE MIND CARE OF PA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 DRESHER RD STE 1100
HORSHAM PA
19044-2216
US

IV. Provider business mailing address

721 DRESHER RD STE 1100
HORSHAM PA
19044-2216
US

V. Phone/Fax

Practice location:
  • Phone: 215-461-5760
  • Fax: 215-754-1705
Mailing address:
  • Phone: 215-461-5760
  • Fax: 215-754-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MANDIE M MATTHEWS
Title or Position: DIRECTOR OF CRED & CONTRACTING
Credential:
Phone: 610-763-9413