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General NPI Number Information
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NPI Number | 1073114823
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Entity Type | Organization
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Legal Business Name | COMMUNITY BEHAVIOR CARE LLC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 221 NE 164TH STREET UNIT 276
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160
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Country | US
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Telephone | 754-217-5335
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Fax | 754-247-3777
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Provider Business Mailing Address
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Address Line | 221 NE 164TH STREET UNIT 276
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160
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Country | US
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Telephone | 754-217-5335
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Fax | 754-247-3777
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN LAPTEV
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Credential |
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Telephone | 754-217-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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