Provider Demographics
NPI:1588947337
Name:FLAGLER MENTAL HEALTH CENTER, PA
Entity type:Organization
Organization Name:FLAGLER MENTAL HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COMFORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-313-1989
Mailing Address - Street 1:2729 E. MOODY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110
Mailing Address - Country:US
Mailing Address - Phone:386-313-1989
Mailing Address - Fax:386-313-1990
Practice Address - Street 1:2729 E. MOODY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110
Practice Address - Country:US
Practice Address - Phone:386-313-1989
Practice Address - Fax:386-313-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty