Organization
MINDOULA CLINICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY COUTO (SVP OPERATIONS)
(954) 650-2802
Entity
Organization
Contact information
Practice address
1117 E WEST HWY, SILVER SPRING, MD 20910-4852
(954) 650-2802
Mailing address
1117 E WEST HWY, SILVER SPRING, MD 20910-4852
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/04/2018
Last updated
08/10/2020
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