Provider Demographics
NPI:1740777556
Name:PATTERNS BEHAVIORAL SERVICES FLORIDA, INC
Entity Type:Organization
Organization Name:PATTERNS BEHAVIORAL SERVICES FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHAHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-206-9594
Mailing Address - Street 1:3230 E IMPERIAL HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-1706
Mailing Address - Country:US
Mailing Address - Phone:657-444-9002
Mailing Address - Fax:714-677-1785
Practice Address - Street 1:12000 N DALE MABRY HWY STE 112
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3311
Practice Address - Country:US
Practice Address - Phone:813-333-5024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022087100Medicaid