MEDICARE: BUILDING BLOCKS BEHAVIOR INTERVENTIONS, LLC

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	251S00000X	Community/Behavioral Health Agency	1-13-15004	FL

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	:	1609284652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS BEHAVIOR INTERVENTIONS, LLC

Provider Business Mailing Address
First Line	:	8757 BRIXFORD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5808
Country	:	US
Telephone Number	:	267-597-1029
Fax Number	:

Provider Business Practice Location Address
First Line	:	8757 BRIXFORD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5808
Country	:	US
Telephone Number	:	267-597-1029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KALI HEIMBACH
Credential	:	BCBA
Telephone Number	:	267-597-1029

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	07/22/2014

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