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General NPI Number Information
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NPI Number | 1780199018
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Entity Type | Organization
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Legal Business Name | MARVELOUS BEHAVIORAL CARE CENTER CORP
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 1125 NE 125TH ST STE 231
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5034
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Country | US
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Telephone | 305-989-9307
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Fax | 305-221-8415
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Provider Business Mailing Address
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Address Line | 1125 NE 125TH ST STE 231
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5034
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Country | US
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Telephone | 305-989-9307
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Fax | 305-221-8415
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Authorized Official
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Title or Position | OWNER
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Name | MARLEN GONZALEZ
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Credential |
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Telephone | 305-812-9123
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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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