Provider Demographics
NPI:1922391721
Name:MGM CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:MGM CASE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SAIMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-827-2822
Mailing Address - Street 1:14411 COMMERCE WAY
Mailing Address - Street 2:320
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1596
Mailing Address - Country:US
Mailing Address - Phone:786-597-3928
Mailing Address - Fax:
Practice Address - Street 1:8040 NW 155TH ST # 320
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5880
Practice Address - Country:US
Practice Address - Phone:305-827-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11622729OtherBACB
FL003554900Medicaid