Healthcare Provider Details

I. General information

NPI: 1174211742
Provider Name (Legal Business Name): BEACON BEHAVIOR CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11077 BISCAYNE BLVD STE 211
MIAMI FL
33161-7419
US

IV. Provider business mailing address

11077 BISCAYNE BLVD STE 211
MIAMI FL
33161-7419
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5388
  • Fax: 305-810-4582
Mailing address:
  • Phone: 305-974-5388
  • Fax: 305-810-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LILLIAM MENENDEZ
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 305-316-1972