Provider Demographics
NPI:1417667080
Name:CH & CH BEHAVIORAL SERVICES IBC
Entity Type:Organization
Organization Name:CH & CH BEHAVIORAL SERVICES IBC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-318-4825
Mailing Address - Street 1:14713 SW 177TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6762
Mailing Address - Country:US
Mailing Address - Phone:786-318-4825
Mailing Address - Fax:
Practice Address - Street 1:14713 SW 177TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6762
Practice Address - Country:US
Practice Address - Phone:786-318-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty