Provider Demographics
NPI:1821577206
Name:ELITE BEHAVIORAL, INC.
Entity Type:Organization
Organization Name:ELITE BEHAVIORAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-209-4190
Mailing Address - Street 1:8074 NW 103RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2256
Mailing Address - Country:US
Mailing Address - Phone:305-209-4190
Mailing Address - Fax:305-508-4302
Practice Address - Street 1:8074 NW 103RD ST STE 2
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2256
Practice Address - Country:US
Practice Address - Phone:305-209-4190
Practice Address - Fax:305-508-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty