Provider Demographics
NPI:1770024473
Name:KEY BEHAVIOR ESSENTIALS, LLC
Entity Type:Organization
Organization Name:KEY BEHAVIOR ESSENTIALS, LLC
Other - Org Name:GUIDED STEPS HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDUEZA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:305-414-4252
Mailing Address - Street 1:18425 NW 2ND AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4525
Mailing Address - Country:US
Mailing Address - Phone:786-916-3706
Mailing Address - Fax:786-916-3708
Practice Address - Street 1:18425 NW 2ND AVE STE 402
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4525
Practice Address - Country:US
Practice Address - Phone:786-916-3706
Practice Address - Fax:786-916-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063832392Medicaid