=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598311805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA BEHAVIORAL & COMMUNITY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2019
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13304 SW 128TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-522-3900
-----------------------------------------------------
Fax | 786-522-3901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13304 SW 128TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-5899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-522-3900
-----------------------------------------------------
Fax | 786-522-3901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VIVIAN BAEZ
-----------------------------------------------------
Credential | CBHCM
-----------------------------------------------------
Telephone | 786-522-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------