=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578232823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDCARE SOLUTIONS GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2021
-----------------------------------------------------
Last Update Date | 12/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4031 ASPEN GROVE DR # 390
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-291-4535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4031 ASPEN GROVE DR # 390
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-291-4535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ROCCO CONIGLIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-969-9019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------