Provider Demographics
NPI:1366035222
Name:SENIORS CARE MENTAL SERVICES CORP
Entity type:Organization
Organization Name:SENIORS CARE MENTAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:PEROZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-332-0041
Mailing Address - Street 1:15506 SW 9TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2415
Mailing Address - Country:US
Mailing Address - Phone:786-332-0041
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 167TH ST STE 170
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5145
Practice Address - Country:US
Practice Address - Phone:786-332-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health