Healthcare Provider Details

I. General information

NPI: 1750884003
Provider Name (Legal Business Name): MGB BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 N W 24 COURT C215
LAUDERHILL FL
33313
US

IV. Provider business mailing address

PO BOX 26121
FORT LAUDERDALE FL
33320-6121
US

V. Phone/Fax

Practice location:
  • Phone: 954-601-6078
  • Fax:
Mailing address:
  • Phone: 954-601-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS MARIE G BATEAU
Title or Position: CASE MANAGER
Credential: M S
Phone: 954-601-6078