Organization Active NPI

Tal Community Mental Health Center LLC

  • Community/Behavioral Health Agency
  • Miramar, FL
National Provider Identifier
1235715236
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
TAL COMMUNITY MENTAL HEALTH CENTER LLC
Practice address
12781 Miramar Parkway
Suite 203
Miramar, FL 33027
Phone
(786) 648-3588
Fax
(786) 698-7677
NPI assigned
Mar 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gaston I Bogomolni
Title
Owner-Cfo
Phone
(786) 648-3588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

12781 Miramar Parkway
Suite 203
Miramar, FL 33027

Mailing address

12781 Miramar Parkway
Suite 203
Miramar, FL 33027
Phone (786) 648-3588

Other identifiers 1

IdentifierTypeStateIssuer
109921400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210804002694 FL Part B Supplier - Clinic/Group Practice 7012311657 Receives reassigned benefits from 2 practitioners
Practice locations: Miramar, FL

National Provider Directory

National Provider Directory

Locations

12781 Miramar Pkwy
Ste 203
Miramar, FL 33027
Phone (786) 648-3588

1400 NE Miami Gardens Dr
Ste 216
North Miami Beach, FL 33179
Phone (786) 830-5880

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1235715236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12781 MIRAMAR PARKWAY",
            "address_2": "SUITE 203",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33027",
            "telephone_number": "786-648-3588",
            "fax_number": "786-698-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12781 MIRAMAR PARKWAY",
            "address_2": "SUITE 203",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33027",
            "telephone_number": "786-648-3588",
            "fax_number": "786-698-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAL COMMUNITY MENTAL HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-20",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "BOGOMOLNI",
        "authorized_official_first_name": "GASTON",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER-CFO",
        "authorized_official_telephone_number": "786-648-3588"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109921400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.