Healthcare Provider Details

I. General information

NPI: 1508031519
Provider Name (Legal Business Name): BTA COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12551 SW 204 TERRCE
MIAMI FL
33177
US

IV. Provider business mailing address

12551 SW 204TH TER
MIAMI FL
33177-5629
US

V. Phone/Fax

Practice location:
  • Phone: 786-267-5997
  • Fax: 305-971-0403
Mailing address:
  • Phone: 786-267-5997
  • Fax: 305-971-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIDGET NANETTE MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential: MS
Phone: 786-267-5997