MEDICARE: CHILDREN OF GOD BEHAVIORAL SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1649989518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN OF GOD BEHAVIORAL SERVICES INC

Provider Business Mailing Address
First Line	:	8305 SW 152ND AVE APT A-115
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-4004
Country	:	US
Telephone Number	:	786-398-3824
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 SW 152ND AVE APT A-115
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-4004
Country	:	US
Telephone Number	:	786-398-3824
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	OSLEIDYS RODRIGUEZ RAVELO
Credential	:
Telephone Number	:	786-398-3824

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/23/2022

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