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General NPI Number Information
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NPI Number | 1811599277
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Entity Type | Organization
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Legal Business Name | NIRVANA MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 3409 POWERLINE RD STE 1104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-5945
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Country | US
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Telephone | 561-962-0792
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Fax | 561-537-2512
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Provider Business Mailing Address
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Address Line | 3409 POWERLINE RD STE 1104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-5945
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Country | US
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Telephone | 561-962-0792
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Fax | 561-537-2512
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Authorized Official
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Title or Position | MEMBER
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Name | MIRENA MONZON
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Credential |
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Telephone | 786-342-9092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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