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General NPI Number Information
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NPI Number | 1588947337
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Entity Type | Organization
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Legal Business Name | FLAGLER MENTAL HEALTH CENTER, PA
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 2729 E. MOODY BLVD STE 105
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City | BUNNELL
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State | FL
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Zip | 32110
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Country | US
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Telephone | 386-313-1989
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Fax | 386-313-1990
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Provider Business Mailing Address
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Address Line | 2729 E. MOODY BLVD STE 105
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City | BUNNELL
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State | FL
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Zip | 32110
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Country | US
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Telephone | 386-313-1989
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Fax | 386-313-1990
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH COMFORT
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Credential |
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Telephone | 386-313-1989
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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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