Healthcare Provider Details

I. General information

NPI: 1922391721
Provider Name (Legal Business Name): MGM CASE MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NW 155TH ST # 320
MIAMI LAKES FL
33016-5880
US

IV. Provider business mailing address

14411 COMMERCE WAY 320
MIAMI LAKES FL
33016-1596
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-2822
  • Fax:
Mailing address:
  • Phone: 786-597-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SAIMARY RIVERO
Title or Position: AUTHORIZED OFFICIAL
Credential: BCBA
Phone: 305-827-2822