Healthcare Provider Details

I. General information

NPI: 1578196721
Provider Name (Legal Business Name): BRAVO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 BOGOTA AVE
HOLLYWOOD FL
33026-4509
US

IV. Provider business mailing address

8140 MCCORMICK BLVD
SKOKIE IL
60076-2920
US

V. Phone/Fax

Practice location:
  • Phone: 872-810-3640
  • Fax:
Mailing address:
  • Phone: 872-810-3640
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDRA SABANAGIC
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 872-810-3540