Basic Information
| Provider Information | |||||||||
| NPI: | 1790447464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETTER LIFE BEHAVIORAL SERVICES OF CENTRAL FLORIDA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7555 CLAXSTRAUSS DR | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342409699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523143760 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Practice Location | |||||||||
| Address1: | 7555 CLAXSTRAUSS DR | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342409699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523143760 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | GUERRERO | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | LYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3523143760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BETTER LIFE BEHAVIORAL SERVICES OF CENTRAL FLORIDA, LLC | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | N | 193200000X MULTI-SPECIALTY GROUP | 106S00000X | N | 193200000X MULTI-SPECIALTY GROUP | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 017486800 | 05 | FL | MEDICAID |