1588065676 NPI number — FAMILY ENRICHMENT BEHAVIORAL HEALTH SYSTEMS II, INC.

Table of content: (NPI 1588065676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588065676 NPI number — FAMILY ENRICHMENT BEHAVIORAL HEALTH SYSTEMS II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY ENRICHMENT BEHAVIORAL HEALTH SYSTEMS II, 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:
1588065676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6067 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 335
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-7947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-367-3600
Provider Business Mailing Address Fax Number:
954-367-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6067 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-7947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-367-3600
Provider Business Practice Location Address Fax Number:
954-367-3601
Provider Enumeration Date:
09/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
YVES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-367-3600

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1821240196 , 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: 675298596 . This is a "MEDICAID WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1821240185 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 675298598 . This is a "FAMILY AND SUPPORT LIVING WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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