Provider Demographics
NPI:1871350694
Name:SON RICE MENTAL CENTER LLC
Entity type:Organization
Organization Name:SON RICE MENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-319-1847
Mailing Address - Street 1:9894 NW 82ND AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2531
Mailing Address - Country:US
Mailing Address - Phone:561-319-1847
Mailing Address - Fax:786-610-1180
Practice Address - Street 1:9894 NW 82ND AVE APT 303
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2531
Practice Address - Country:US
Practice Address - Phone:561-319-1847
Practice Address - Fax:786-610-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty