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General NPI Number Information
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NPI Number | 1083152904
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Entity Type | Organization
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Legal Business Name | AVANTAGE BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 02/11/2017
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 18690 NW 2ND AVE 100
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4508
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Country | US
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Telephone | 754-423-9194
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 268175
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City | WESTON
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State | FL
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Zip | 33326-8175
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARNEL THELUSMA
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Credential |
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Telephone | 954-226-2812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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