Healthcare Provider Details

I. General information

NPI: 1689266678
Provider Name (Legal Business Name): SUPERHERO KIDDOS - ABA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NE 155TH TER
NORTH MIAMI BEACH FL
33162-5623
US

IV. Provider business mailing address

1401 NE 155TH TER
NORTH MIAMI BEACH FL
33162-5623
US

V. Phone/Fax

Practice location:
  • Phone: 786-458-3836
  • Fax:
Mailing address:
  • Phone: 786-458-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LINETH DASILVA
Title or Position: OWNER
Credential:
Phone: 786-458-3836