Organization
TAL COMMUNITY MENTAL HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GASTON I BOGOMOLNI (OWNER-CFO)
(786) 648-3588
Entity
Organization
Contact information
Practice address
12781 MIRAMAR PARKWAY, SUITE 203, MIRAMAR, FL 33027
(786) 648-3588
(786) 698-7677
Mailing address
12781 MIRAMAR PARKWAY, SUITE 203, MIRAMAR, FL 33027
(786) 648-3588
(786) 698-7677
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109921400
—
FL
Enumeration date
03/20/2021
Last updated
12/12/2022
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