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General NPI Number Information
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NPI Number | 1891579538
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Entity Type | Organization
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Legal Business Name | ELDER LIFE MENTAL HEALTH INC
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 18142 SW 97TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5501
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Country | US
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Telephone | 786-830-4316
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Fax |
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Provider Business Mailing Address
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Address Line | 18142 SW 97TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5501
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Country | US
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Telephone | 786-830-4316
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETSY GUEVARA RUIZ
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Credential | RBT
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Telephone | 786-830-4316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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