NPIMap

Organization Active NPI

Blue Clinical Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Myers, FL
National Provider Identifier
1417774597
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BLUE CLINICAL CENTER LLC
Practice address
6300 Corporate CT
Fort Myers, FL 33919-3513
Phone
(786) 803-8517
NPI assigned
Sep 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Authorized official

Name
Alexandra Codecido
Title
Owner
Phone
(786) 663-2822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

6300 Corporate CT
Fort Myers, FL 33919-3513

Mailing address

6300 Corporate CT
Fort Myers, FL 33919-3513

National Provider Directory

National Provider Directory
Tax ID family
Blue Clinical Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1417774597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 CORPORATE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 CORPORATE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193513",
            "telephone_number": "786-803-8517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CLINICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "CODECIDO",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-663-2822"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.