| Arc Mental Health | |
|
14400 Nw 77th Ct Ste 100 Miami Lakes FL 33016-1590 | |
| (786) 916-6073 | |
| (786) 657-3092 |
| Full Name | Arc Mental Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 14400 Nw 77th Ct Ste 100, Miami Lakes, Florida |
| Authorized Official Name and Position | Michelle T Reichard (CEO) |
| Authorized Official Contact | 7874573777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arc Mental Health 14400 Nw 77th Ct Ste 100 Miami Lakes FL 33016-1590 Ph: (786) 916-6073 | Arc Mental Health 14400 Nw 77th Ct Ste 100 Miami Lakes FL 33016-1590 Ph: (786) 916-6073 |
| NPI Number | 1982102901 |
|---|---|
| Provider Enumeration Date | 01/24/2018 |
| Last Update Date | 08/17/2022 |
| Certification Date | 08/17/2022 |
| Medicare PECOS PAC ID | 8921425158 |
|---|---|
| Medicare Enrollment ID | O20200902000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982102901 | NPI | - | NPPES |
| 104616600 | Medicaid | FL | |
| 107662100 | Medicaid | FL |
| Provider Name | Ileana D Dominguez Baute |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659907178 PECOS PAC ID: 1254757644 Enrollment ID: I20200817000631 |
| Provider Name | Luis Manuel Gomez Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063043164 PECOS PAC ID: 7719399500 Enrollment ID: I20201221000937 |
| Provider Name | Jason Lopez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659802916 PECOS PAC ID: 9335549518 Enrollment ID: I20210609001412 |
| Provider Name | Ibis Reyes Soto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548804164 PECOS PAC ID: 3476954603 Enrollment ID: I20210625001222 |
| Provider Name | Michelle Reichard Stubbe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003450289 PECOS PAC ID: 8820415052 Enrollment ID: I20231130000156 |
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