1457319451 NPI number — MIAMI BEHAVIORAL HEALTH CENTER INC

Table of content: (NPI 1457319451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457319451 NPI number — MIAMI BEHAVIORAL HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAMI BEHAVIORAL HEALTH CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457319451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 BLUE LAGOON DR
Provider Second Line Business Mailing Address:
SUITE400
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-398-6100
Provider Business Mailing Address Fax Number:
305-757-2387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 W FLAGLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33134-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-774-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ILEANA
Authorized Official Middle Name:
RUIZ
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
305-398-6100

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1113AD777700 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 1113AD777700 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002340400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305824 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109574900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305815 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305810 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305828 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305818 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305819 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305803 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305804 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305805 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305806 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305811 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305812 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305822 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305808 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060305816 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008136900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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