Healthcare Provider Details

I. General information

NPI: 1285492991
Provider Name (Legal Business Name): B RILEY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SW 1ST ST
MIAMI FL
33135-2203
US

IV. Provider business mailing address

1420 SW 1ST ST
MIAMI FL
33135-2203
US

V. Phone/Fax

Practice location:
  • Phone: 786-620-8008
  • Fax:
Mailing address:
  • Phone: 786-620-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL ANTONIO CORREA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-417-4831