| Bluehaven Psychiatry Pllc | |
|
3960 Broadway Blvd Ste 140 Garland TX 75043-2593 | |
| (316) 516-4972 | |
| Not Available |
| Full Name | Bluehaven Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3960 Broadway Blvd Ste 140, Garland, Texas |
| Authorized Official Name and Position | Ngomeni M Mbilikira (CEO) |
| Authorized Official Contact | 2144321669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluehaven Psychiatry Pllc 940 W Fm 544 Unit 625 Wylie TX 75098-3330 Ph: (214) 432-1669 | Bluehaven Psychiatry Pllc 3960 Broadway Blvd Ste 140 Garland TX 75043-2593 Ph: (316) 516-4972 |
| NPI Number | 1215718184 |
|---|---|
| Provider Enumeration Date | 10/09/2023 |
| Last Update Date | 02/19/2024 |
| Certification Date | 02/19/2024 |
| Medicare PECOS PAC ID | 1456708650 |
|---|---|
| Medicare Enrollment ID | O20231109001759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215718184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ngomeni Mbilikira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578251070 PECOS PAC ID: 3678927308 Enrollment ID: I20230928001160 |
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