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General NPI Number Information
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NPI Number | 1285662841
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Entity Type | Organization
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Legal Business Name | HOMESTEAD BEHAVIORAL CLINIC, INC.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 654 NE 9TH PL
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City | HOMESTEAD
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State | FL
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Zip | 33030-4934
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Country | US
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Telephone | 305-248-3488
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Fax | 305-248-6558
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Provider Business Mailing Address
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Address Line | 654 NE 9TH PL
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City | HOMESTEAD
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State | FL
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Zip | 33030-4934
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Country | US
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Telephone | 305-248-3488
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Fax | 305-248-6558
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Authorized Official
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Title or Position | CEO
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Name | AIDELYN LOPEZ
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Credential |
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Telephone | 305-248-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | HCC 4035
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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 | HCC4181
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | HCC4181
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License Number State | FL
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