Healthcare Provider Details

I. General information

NPI: 1740777556
Provider Name (Legal Business Name): PATTERNS BEHAVIORAL SERVICES FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 N DALE MABRY HWY STE 112
TAMPA FL
33618-3311
US

IV. Provider business mailing address

3230 E IMPERIAL HWY STE 203
BREA CA
92821-1706
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-5024
  • Fax:
Mailing address:
  • Phone: 657-444-9002
  • Fax: 714-677-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyCommunity Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: IHAB F SHAHAWI
Title or Position: CEO
Credential:
Phone: 657-206-9594