MEDICARE: ACTIVE SUPPORT BEHAVIOR CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285236638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE SUPPORT BEHAVIOR CORP

Provider Business Mailing Address
First Line	:	6383 10TH AVE N STE E
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-1689
Country	:	US
Telephone Number	:	561-729-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	6383 10TH AVE N STE E
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-1689
Country	:	US
Telephone Number	:	561-729-4148
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FLAVIA FIGUEREDO DE LA GUARDIA
Credential	:
Telephone Number	:	561-729-4148

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	01/05/2026

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