Provider Demographics
NPI:1154932457
Name:MENTAL CARE MEDICAL CENTER INC
Entity type:Organization
Organization Name:MENTAL CARE MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AMADOR RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-788-6644
Mailing Address - Street 1:7925 NW 12TH ST STE 225
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1821
Mailing Address - Country:US
Mailing Address - Phone:305-788-6644
Mailing Address - Fax:
Practice Address - Street 1:7925 NW 12TH ST STE 225
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1821
Practice Address - Country:US
Practice Address - Phone:305-788-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110034600Medicaid
FL117263400Medicaid
FL107706300Medicaid