1497347272 NPI number — CHILD BEHAVIOR CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497347272 NPI number — CHILD BEHAVIOR CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD BEHAVIOR 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:
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:
1497347272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3051 MENORCA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34744-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-303-4819
Provider Business Mailing Address Fax Number:
866-532-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
897 TOWNE CENTER DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34759-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-303-4819
Provider Business Practice Location Address Fax Number:
866-532-6911
Provider Enumeration Date:
02/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA-GONZALEZ
Authorized Official First Name:
LOURDES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-303-4819

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113124900 . 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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