Healthcare Provider Details

I. General information

NPI: 1881233690
Provider Name (Legal Business Name): MR. MAX AUGUSTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 NW 1ST AVE
NORTH MIAMI FL
33168-4601
US

IV. Provider business mailing address

19255 NE 10TH AVE APT 505
NORTH MIAMI BEACH FL
33179-5947
US

V. Phone/Fax

Practice location:
  • Phone: 305-539-9242
  • Fax:
Mailing address:
  • Phone: 786-445-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: