NPIMap

Organization Active NPI

Complete Mind Care of PA, LLC

  • Adult Mental Health Clinic/Center
  • Villanova, PA
National Provider Identifier
1639947492
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
COMPLETE MIND CARE OF PA, LLC
Practice address
795 E Lancaster Ave Ste 210
Villanova, PA 19085-1525
Phone
(215) 461-5760
Fax
(215) 754-1705
NPI assigned
Dec 12, 2023
Last updated
Dec 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Mandie M Matthews
Title
Director of Cred & Contracting
Phone
(610) 763-9413

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Adult Mental Health Clinic/Center 261QM0850X NU Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

795 E Lancaster Ave Ste 210
Villanova, PA 19085-1525

Mailing address

795 E Lancaster Ave Ste 210
Villanova, PA 19085-1525
Phone (215) 461-5760

National Provider Directory

National Provider Directory
Tax ID family
Complete Mind Care of PA 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": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1639947492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 E LANCASTER AVE STE 210",
            "city": "VILLANOVA",
            "state": "PA",
            "postal_code": "190851525",
            "telephone_number": "215-461-5760",
            "fax_number": "215-754-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 E LANCASTER AVE STE 210",
            "city": "VILLANOVA",
            "state": "PA",
            "postal_code": "190851525",
            "telephone_number": "215-461-5760",
            "fax_number": "215-754-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE MIND CARE OF PA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-12",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "MANDIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF CRED & CONTRACTING",
        "authorized_official_telephone_number": "610-763-9413"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villanova, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.