Basic Information
Provider Information | |||||||||
NPI: | 1457319451 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MIAMI BEHAVIORAL HEALTH CENTER INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SPECTRUM PROGRAMS INC | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
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: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 1113AD777700 | FL | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 101Y00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |   | 1041C0700X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |   | 106H00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 2080A0000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 2084P0800X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 101YA0400X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 164W00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse |   | 363LP0808X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163W00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |   | 376J00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Homemaker |   | 207Q00000X |   |   | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   | 101YM0800X | 1113AD777700 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 002340400 | 05 | FL |   | MEDICAID | 060305824 | 05 | FL |   | MEDICAID | 109574900 | 05 | FL |   | MEDICAID | 060305815 | 05 | FL |   | MEDICAID | 060305810 | 05 | FL |   | MEDICAID | 060305828 | 05 | FL |   | MEDICAID | 060305800 | 05 | FL |   | MEDICAID | 060305818 | 05 | FL |   | MEDICAID | 060305819 | 05 | FL |   | MEDICAID | 060305803 | 05 | FL |   | MEDICAID | 060305804 | 05 | FL |   | MEDICAID | 060305805 | 05 | FL |   | MEDICAID | 060305806 | 05 | FL |   | MEDICAID | 060305811 | 05 | FL |   | MEDICAID | 060305812 | 05 | FL |   | MEDICAID | 060305822 | 05 | FL |   | MEDICAID | 060305808 | 05 | FL |   | MEDICAID | 060305816 | 05 | FL |   | MEDICAID |