Provider Demographics
NPI:1912344268
Name:MERCY BEHAVIORAL CENTER INC
Entity type:Organization
Organization Name:MERCY BEHAVIORAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-883-5188
Mailing Address - Street 1:705 EAST 8TH AVE SUITE 101 AND 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010
Mailing Address - Country:US
Mailing Address - Phone:305-883-5188
Mailing Address - Fax:305-883-5188
Practice Address - Street 1:705 E 8TH AVE
Practice Address - Street 2:SUITE 101 AND 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4613
Practice Address - Country:US
Practice Address - Phone:305-883-5188
Practice Address - Fax:305-883-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL007376700251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007376700Medicaid