Provider Demographics
NPI:1720885395
Name:MINDCARE CLINIC, LLC
Entity type:Organization
Organization Name:MINDCARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CEVALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-799-0068
Mailing Address - Street 1:633 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4050
Mailing Address - Country:US
Mailing Address - Phone:786-799-0068
Mailing Address - Fax:
Practice Address - Street 1:633 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4050
Practice Address - Country:US
Practice Address - Phone:786-799-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management