Provider Demographics
NPI:1073840351
Name:BEHAVERUS INC.
Entity Type:Organization
Organization Name:BEHAVERUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FL-CBA
Authorized Official - Phone:407-579-2507
Mailing Address - Street 1:9542 BRACKIN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6124
Mailing Address - Country:US
Mailing Address - Phone:407-579-2507
Mailing Address - Fax:
Practice Address - Street 1:9542 BRACKIN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6124
Practice Address - Country:US
Practice Address - Phone:407-579-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0215261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities