Provider Demographics
NPI:1083152904
Name:AVANTAGE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:AVANTAGE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THELUSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-226-2812
Mailing Address - Street 1:PO BOX 268175
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-8175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18690 NW 2ND AVE
Practice Address - Street 2:100
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4508
Practice Address - Country:US
Practice Address - Phone:754-423-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-11
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management