Healthcare Provider Details

I. General information

NPI: 1598120156
Provider Name (Legal Business Name): ARK PROVISION ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 NW 173RD DR UNIT 11
HIALEAH FL
33015-5122
US

IV. Provider business mailing address

17333 NW 62ND PL
HIALEAH FL
33015-4502
US

V. Phone/Fax

Practice location:
  • Phone: 786-655-9992
  • Fax: 786-734-8142
Mailing address:
  • Phone: 786-486-4026
  • Fax: 305-826-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUISA RAMIREZ
Title or Position: CEO
Credential: LCSW
Phone: 786-486-4026