Provider Demographics
NPI:1609439140
Name:BEHAVIORAL HEALTH & WELLNESS OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH & WELLNESS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:305-924-7299
Mailing Address - Street 1:11285 SW 211TH ST # 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2211
Mailing Address - Country:US
Mailing Address - Phone:786-592-1001
Mailing Address - Fax:786-592-1024
Practice Address - Street 1:11285 SW 211TH ST # 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2211
Practice Address - Country:US
Practice Address - Phone:786-592-1001
Practice Address - Fax:786-592-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health