Provider Demographics
NPI:1922863299
Name:HOPEFUL REBIRTH BEHAVIORAL AGENCY LLC
Entity Type:Organization
Organization Name:HOPEFUL REBIRTH BEHAVIORAL AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-281-1070
Mailing Address - Street 1:2426 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6512
Mailing Address - Country:US
Mailing Address - Phone:786-281-1070
Mailing Address - Fax:
Practice Address - Street 1:6300 CORPORATE CT STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3513
Practice Address - Country:US
Practice Address - Phone:786-281-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty