Provider Demographics
NPI:1558310169
Name:KETER BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:KETER BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-650-4929
Mailing Address - Street 1:5190 NW 167TH ST
Mailing Address - Street 2:STE 109
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6328
Mailing Address - Country:US
Mailing Address - Phone:305-620-4929
Mailing Address - Fax:305-620-4954
Practice Address - Street 1:5190 NW 167TH ST
Practice Address - Street 2:STE 109
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6328
Practice Address - Country:US
Practice Address - Phone:305-620-4929
Practice Address - Fax:305-620-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101482Medicare Oscar/Certification