Provider Demographics
NPI:1285199893
Name:ALTERNATIVES BEHAVIORAL GROUP, INC.
Entity Type:Organization
Organization Name:ALTERNATIVES BEHAVIORAL GROUP, INC.
Other - Org Name:ALTERNATIVES BEHAVIORAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PITALUGA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-807-7135
Mailing Address - Street 1:1360 S DIXIE HWY STE 350
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2904
Mailing Address - Country:US
Mailing Address - Phone:305-807-7135
Mailing Address - Fax:
Practice Address - Street 1:1360 S DIXIE HWY STE 350
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2904
Practice Address - Country:US
Practice Address - Phone:305-648-9344
Practice Address - Fax:305-316-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023635800Medicaid