Provider Demographics
NPI:1093588410
Name:EDYE RBT SERVICE LLC
Entity Type:Organization
Organization Name:EDYE RBT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YRAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-439-7521
Mailing Address - Street 1:810 NE 143RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2330
Mailing Address - Country:US
Mailing Address - Phone:130-543-9752
Mailing Address - Fax:
Practice Address - Street 1:810 NE 143RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2330
Practice Address - Country:US
Practice Address - Phone:305-439-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty