Provider Demographics
NPI:1386265122
Name:MONARCH MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:MONARCH MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDENIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-973-5533
Mailing Address - Street 1:1314 E LAS OLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2334
Mailing Address - Country:US
Mailing Address - Phone:954-973-5533
Mailing Address - Fax:954-337-3721
Practice Address - Street 1:648 NW 183 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169
Practice Address - Country:US
Practice Address - Phone:954-973-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952715682OtherNPI
FL1447695184OtherNPI
FL1225398852OtherNPI