Healthcare Provider Details

I. General information

NPI: 1659933273
Provider Name (Legal Business Name): BTLC SERVICES 1 CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 SW 115TH TER
MIAMI FL
33186-4729
US

IV. Provider business mailing address

12851 SW 115TH TER
MIAMI FL
33186-4729
US

V. Phone/Fax

Practice location:
  • Phone: 786-452-0582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLGA E. PRESAS
Title or Position: CEO
Credential:
Phone: 786-452-0582