Healthcare Provider Details

I. General information

NPI: 1801602594
Provider Name (Legal Business Name): HOMESTEAD BEHAVIORAL CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 290
DORAL FL
33122-1090
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 290
DORAL FL
33122-1090
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-8488
  • Fax:
Mailing address:
  • Phone: 786-803-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DAMIAN OLIVEROS
Title or Position: OWNER
Credential: RBT
Phone: 305-283-3025