Basic Information
| Provider Information | |||||||||
| NPI: | 1851407365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENTAL HEALTH RESOURCE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19249 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322459249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047431883 | ||||||||
| FaxNumber: | 9047435109 | ||||||||
| Practice Location | |||||||||
| Address1: | 11820 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322466670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046429100 | ||||||||
| FaxNumber: | 9046429108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | SOMMERS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9047431883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 273R00000X | N | Hospital Units | Psychiatric Unit | 283Q00000X | N | Hospitals | Psychiatric Hospital | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 060293100 | 05 | FL | MEDICAID | 060293105 | 05 | FL | MEDICAID | 060293113 | 05 | FL | MEDICAID | 060293114 | 05 | FL | MEDICAID | 060293111 | 05 | FL | MEDICAID | 060293106 | 05 | FL | MEDICAID | 261464200 | 05 | FL | MEDICAID | 99464 | 01 | FL | MEDICARE PART B ONLY | OTHER | 060293102 | 05 | FL | MEDICAID | 060293112 | 05 | FL | MEDICAID |