Provider Demographics
NPI: | 1518630508 |
---|---|
Name: | COLORFUL SMILE BEHAVIORAL & HOME SERVICES INC. |
Entity Type: | Organization |
Organization Name: | COLORFUL SMILE BEHAVIORAL & HOME SERVICES INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RAMOS HERNANDEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-439-5707 |
Mailing Address - Street 1: | 5725 CORPORATE WAY STE 207 |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST PALM BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33407-2035 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-484-5552 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5725 CORPORATE WAY STE 207 |
Practice Address - Street 2: | |
Practice Address - City: | WEST PALM BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33407-2035 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-806-1798 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-07-27 |
Last Update Date: | 2021-08-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty |