Basic Information
Provider Information
NPI: 1457319451
EntityType: 2
ReplacementNPI:  
OrganizationName: MIAMI BEHAVIORAL HEALTH CENTER INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: SPECTRUM PROGRAMS INC
OtherOrganizationType: 5
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6100 BLUE LAGOON DR
Address2: SUITE400
City: MIAMI
State: FL
PostalCode: 331262079
CountryCode: US
TelephoneNumber: 3053986100
FaxNumber: 3057572387
Practice Location
Address1: 3850 W FLAGLER ST
Address2:  
City: CORAL GABLES
State: FL
PostalCode: 331341604
CountryCode: US
TelephoneNumber: 3057743300
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/02/2006
LastUpdateDate: 10/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GARCIA
AuthorizedOfficialFirstName: ILEANA
AuthorizedOfficialMiddleName: RUIZ
AuthorizedOfficialTitleorPosition: COO
AuthorizedOfficialTelephone: 3053986100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential: MSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0801X1113AD777700FLN Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
101Y00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselor 
1041C0700X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersSocial WorkerClinical
104100000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersSocial Worker 
106H00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersMarriage & Family Therapist 
2080A0000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
2084P0800X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0804X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
101YA0400X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
164W00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPNursing Service ProvidersLicensed Practical Nurse 
363LP0808X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health
163W00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPNursing Service ProvidersRegistered Nurse 
376J00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPNursing Service Related ProvidersHomemaker 
207Q00000X  N193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
101YM0800X1113AD777700FLY193400000X MULTIPLE SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorMental Health

ID Information
IDTypeStateIssuerDescription
00234040005FL MEDICAID
06030582405FL MEDICAID
10957490005FL MEDICAID
06030581505FL MEDICAID
06030581005FL MEDICAID
06030582805FL MEDICAID
06030580005FL MEDICAID
06030581805FL MEDICAID
06030581905FL MEDICAID
06030580305FL MEDICAID
06030580405FL MEDICAID
06030580505FL MEDICAID
06030580605FL MEDICAID
06030581105FL MEDICAID
06030581205FL MEDICAID
06030582205FL MEDICAID
06030580805FL MEDICAID
06030581605FL MEDICAID


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