Provider Demographics
NPI:1700219730
Name:FAVY HCS, INC.
Entity Type:Organization
Organization Name:FAVY HCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-443-9221
Mailing Address - Street 1:12360 SW 132ND CT STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6461
Mailing Address - Country:US
Mailing Address - Phone:786-429-3738
Mailing Address - Fax:305-397-2416
Practice Address - Street 1:12360 SW 132ND CT STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6461
Practice Address - Country:US
Practice Address - Phone:786-429-3738
Practice Address - Fax:305-397-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003015700Medicaid
FL005564800Medicaid
FL003015700OtherMEDICAID WAIVER
FL017450000Medicaid