Healthcare Provider Details

I. General information

NPI: 1285662841
Provider Name (Legal Business Name): HOMESTEAD BEHAVIORAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/29/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 NE 9TH PL
HOMESTEAD FL
33030-4934
US

IV. Provider business mailing address

654 NE 9TH PL
HOMESTEAD FL
33030-4934
US

V. Phone/Fax

Practice location:
  • Phone: 305-248-3488
  • Fax: 305-248-6558
Mailing address:
  • Phone: 305-248-3488
  • Fax: 305-248-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberHCC 4035
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberHCC4181
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberHCC4181
License Number StateFL

VIII. Authorized Official

Name: AIDELYN LOPEZ
Title or Position: CEO
Credential:
Phone: 305-248-3488