Organization · NPI-2

11911 Pine Forest Drive, New Port Ritchey 34654

Clinic/Center, Adult Mental Health · New Port Richey, FL

NPI number1912532441
StatusActive
Last updated in NPPESMar 16, 2020

Details

NPI
1912532441
Entity type
Organization (NPI-2)
Legal business name
11911 Pine Forest Drive, New Port Ritchey 34654
Organization subpart
No
Enumeration date
Mar 4, 2020
Certification date
Mar 16, 2020
Last updated
Mar 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0850X Clinic/Center, Adult Mental Health––Yes

Practice location

11911 Pine Forest Dr
New Port Richey, FL 34654-1462

Phone 813-526-4155

Mailing address

10144 Arbor Run Dr Unit 28
Tampa, FL 33647-3568

Phone 813-526-4155

Authorized official

Neveh Mahilum
Owner/Manager
8135264155

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