Healthcare Provider Details

I. General information

NPI: 1679272686
Provider Name (Legal Business Name): URP BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 17TH ST
RIVIERA BEACH FL
33404-6121
US

IV. Provider business mailing address

9050 PINES BLVD STE 460
PEMBROKE PINES FL
33024-6459
US

V. Phone/Fax

Practice location:
  • Phone: 954-549-9679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KAYLA MACDONALD
Title or Position: COO
Credential:
Phone: 954-654-9072