Provider Demographics
NPI:1073114823
Name:COMMUNITY BEHAVIOR CARE LLC
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPTEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-217-5335
Mailing Address - Street 1:221 NE 164TH STREET
Mailing Address - Street 2:UNIT 276
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:754-217-5335
Mailing Address - Fax:754-247-3777
Practice Address - Street 1:221 NE 164TH STREET
Practice Address - Street 2:UNIT 276
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:754-217-5335
Practice Address - Fax:754-247-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)