MEDICARE: MINDCARE OF AMERICA 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538907100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDCARE OF AMERICA LLC

Provider Business Mailing Address
First Line	:	9465 WORSWICK CT
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6423
Country	:	US
Telephone Number	:	561-797-0724
Fax Number	:	833-502-4172

Provider Business Practice Location Address
First Line	:	5813 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1347
Country	:	US
Telephone Number	:	561-797-0724
Fax Number	:	833-502-4172

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	EZECHIEL MADESTIN
Credential	:	DNP
Telephone Number	:	561-797-0724

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	02/20/2026

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