Provider Demographics
NPI:1962058057
Name:MCW MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MCW MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOFRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-453-0743
Mailing Address - Street 1:1701 GREEN RD STE C
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1074
Mailing Address - Country:US
Mailing Address - Phone:561-453-0743
Mailing Address - Fax:561-453-0743
Practice Address - Street 1:4461 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3280
Practice Address - Country:US
Practice Address - Phone:561-453-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder