MEDICARE: REGA MENTAL HEALTH CENTER, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCC7498	OTHER	FL	AHCA FLORIDA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578234381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGA MENTAL HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	7501 WILES RD STE 105
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-346-8300
Fax Number	:	954-346-8300

Provider Business Practice Location Address
First Line	:	3219 W 4TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5308
Country	:	US
Telephone Number	:	305-261-6633
Fax Number	:	305-261-6680

Authorized Official
Title or Position	:	OWNER
Name	:	RICARDO ESPAILLAT
Credential	:	MD
Telephone Number	:	954-346-8300

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/06/2023

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