Provider Demographics
NPI:1194379628
Name:DAESA BEHAVIOR HEALTH INC
Entity Type:Organization
Organization Name:DAESA BEHAVIOR HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-955-5744
Mailing Address - Street 1:17325 NW 27TH AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4000
Mailing Address - Country:US
Mailing Address - Phone:786-955-5744
Mailing Address - Fax:
Practice Address - Street 1:17325 NW 27TH AVE STE 111
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4000
Practice Address - Country:US
Practice Address - Phone:786-955-5744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health