Provider Demographics
NPI:1851057558
Name:KIDS HAVEN BEHAVIOR CORP
Entity Type:Organization
Organization Name:KIDS HAVEN BEHAVIOR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YESSENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITURRALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-357-5475
Mailing Address - Street 1:1200 N FEDERAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2813
Mailing Address - Country:US
Mailing Address - Phone:786-357-5475
Mailing Address - Fax:
Practice Address - Street 1:1200 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-2813
Practice Address - Country:US
Practice Address - Phone:786-357-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty