MEDICARE: ELITE BEHAVIOR SPECIALIST

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

General Provider Information

NPI Number	:	1447757414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE BEHAVIOR SPECIALIST

Provider Business Mailing Address
First Line	:	8942 NW 112TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4578
Country	:	US
Telephone Number	:	786-427-5745
Fax Number	:

Provider Business Practice Location Address
First Line	:	8942 NW 112TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4578
Country	:	US
Telephone Number	:	786-427-5745
Fax Number	:

Authorized Official
Title or Position	:	PRESEDENT
Name	:	CHABELLY RUBI
Credential	:
Telephone Number	:	786-427-5745

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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