| Life Well Behavioral Health Center, Inc. | |
|
2801 Nw 87th Ave Ste 7 Doral FL 33172-1604 | |
| (786) 717-6881 | |
| (786) 717-6355 |
| Full Name | Life Well Behavioral Health Center, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2801 Nw 87th Ave Ste 7, Doral, Florida |
| Authorized Official Name and Position | Lianet Gonzalez (PRESIDENT) |
| Authorized Official Contact | 7867598995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Well Behavioral Health Center, Inc. 2801 Nw 87th Ave Ste 7 Doral FL 33172-1604 Ph: (786) 717-6881 | Life Well Behavioral Health Center, Inc. 2801 Nw 87th Ave Ste 7 Doral FL 33172-1604 Ph: (786) 717-6881 |
| NPI Number | 1619360641 |
|---|---|
| Provider Enumeration Date | 03/16/2015 |
| Last Update Date | 08/16/2021 |
| Certification Date | 08/16/2021 |
| Medicare PECOS PAC ID | 7315210218 |
|---|---|
| Medicare Enrollment ID | O20170828004274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619360641 | NPI | - | NPPES |
| 019851500 | Medicaid | FL |
| Provider Name | Nelson D Hernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285625079 PECOS PAC ID: 5496743221 Enrollment ID: I20040503000213 |
| Provider Name | Jose Gregorio Aguilar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194184242 PECOS PAC ID: 5991092660 Enrollment ID: I20170224000434 |
| Provider Name | Rafael Rojas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326285636 PECOS PAC ID: 6507133063 Enrollment ID: I20171205001835 |
| Provider Name | Eric Rafael Campillo-juig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205039005 PECOS PAC ID: 6901173566 Enrollment ID: I20171220002705 |
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