Provider Demographics
NPI:1699363291
Name:JUMPSTART DEVELOPMENTAL SERVICES LLC
Entity Type:Organization
Organization Name:JUMPSTART DEVELOPMENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-879-5458
Mailing Address - Street 1:5979 NW 151ST ST STE 102I
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2434
Mailing Address - Country:US
Mailing Address - Phone:786-431-5801
Mailing Address - Fax:786-353-9177
Practice Address - Street 1:5979 NW 151ST ST STE 102I
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2434
Practice Address - Country:US
Practice Address - Phone:786-431-5801
Practice Address - Fax:786-353-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103180400Medicaid