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NPI Code Detail

MEDICARE: BALANCED MIND INTEGRATIVE CARE, LLC

MEDICARE: BALANCED MIND INTEGRATIVE CARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346837812
Entity Type Code : Organization
Provider Name (Legal Business Name) : BALANCED MIND INTEGRATIVE CARE, LLC
Provider Business Mailing Address
First Line : 3440 HOLLYWOOD BLVD STE 415
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-6933
Country : US
Telephone Number : 954-295-7116
Fax Number :
Provider Business Practice Location Address
First Line : 3440 HOLLYWOOD BLVD STE 415
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-6933
Country : US
Telephone Number : 954-367-2313
Fax Number :
Authorized Official
Title or Position : OWNER OF ENTITY
Name : SARA GENA ISRAEL
Credential : APRN
Telephone Number : 954-295-7116
Provider Enumeration Date : 12/30/2020
Last Update Date : 07/18/2024

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