=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578272860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHT DAYS BEHAVIOR INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2022
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16657 SW 81ST TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-5755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-956-6206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16657 SW 81ST TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33193-5755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-956-6206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMANDA GARCIA JIMENEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-956-6206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------