Provider Demographics
NPI:1013742717
Name:AJM BEHAVIOR WELLNESS CENTER, CO
Entity type:Organization
Organization Name:AJM BEHAVIOR WELLNESS CENTER, CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MARIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANRESA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:786-354-3505
Mailing Address - Street 1:306 ALCAZAR AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4318
Mailing Address - Country:US
Mailing Address - Phone:305-967-8725
Mailing Address - Fax:305-967-8446
Practice Address - Street 1:306 ALCAZAR AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4318
Practice Address - Country:US
Practice Address - Phone:305-967-8725
Practice Address - Fax:305-967-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health