Provider Demographics
NPI:1932685567
Name:FBC-HEALTHCARE
Entity Type:Organization
Organization Name:FBC-HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREISY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA MOJENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-521-6511
Mailing Address - Street 1:1800 N BAYSHORE DR APT 4010
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-3235
Mailing Address - Country:US
Mailing Address - Phone:786-521-6511
Mailing Address - Fax:
Practice Address - Street 1:1800 N BAYSHORE DR APT 4010
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3235
Practice Address - Country:US
Practice Address - Phone:786-521-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2968103K00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty