Provider Demographics
NPI:1912367558
Name:BEHAVIOR SUPPORT CENTER OF FLORIDA INC
Entity Type:Organization
Organization Name:BEHAVIOR SUPPORT CENTER OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-587-6748
Mailing Address - Street 1:15305 NW 60TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2461
Mailing Address - Country:US
Mailing Address - Phone:786-536-7561
Mailing Address - Fax:305-437-8180
Practice Address - Street 1:15305 NW 60TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2461
Practice Address - Country:US
Practice Address - Phone:786-536-7561
Practice Address - Fax:786-437-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019938200Medicaid
FL105546400Medicaid