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General NPI Number Information
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NPI Number | 1487242483
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Entity Type | Organization
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Legal Business Name | FAMILY CARE MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 04/04/2021
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Provider Practice Location Address
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Address Line | 9340 N FLORIDA AVE STE F
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City | TAMPA
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State | FL
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Zip | 33612-7925
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Country | US
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Telephone | 813-703-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 13919 BRIARDALE LN
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City | TAMPA
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State | FL
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Zip | 33618-2115
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Country | US
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Telephone | 813-703-0016
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAVIER VALDES BANGUELA
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Credential |
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Telephone | 813-703-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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