Healthcare Provider Details

I. General information

NPI: 1811413768
Provider Name (Legal Business Name): CRYSTAL KIDS DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 NE 6TH AVE
NORTH MIAMI BEACH FL
33162-2008
US

IV. Provider business mailing address

17121 NE 6TH AVE
NORTH MIAMI BEACH FL
33162-2008
US

V. Phone/Fax

Practice location:
  • Phone: 305-952-3161
  • Fax: 786-364-7244
Mailing address:
  • Phone: 305-952-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: INNIA S PEREIRA
Title or Position: PRESIDENT
Credential:
Phone: 305-924-4747