Provider Demographics
| NPI: | 1457319451 |
|---|---|
| Name: | MIAMI BEHAVIORAL HEALTH CENTER INC |
| Entity Type: | Organization |
| Organization Name: | MIAMI BEHAVIORAL HEALTH CENTER INC |
| Other - Org Name: | SPECTRUM PROGRAMS INC |
| Other - Org Type: | Other Name |
| Authorized Official - Title/Position: | COO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ILEANA |
| Authorized Official - Middle Name: | RUIZ |
| Authorized Official - Last Name: | GARCIA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MSW |
| Authorized Official - Phone: | 305-398-6100 |
| Mailing Address - Street 1: | 6100 BLUE LAGOON DR |
| Mailing Address - Street 2: | SUITE400 |
| Mailing Address - City: | MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33126-2079 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 305-398-6100 |
| Mailing Address - Fax: | 305-757-2387 |
| Practice Address - Street 1: | 3850 W FLAGLER ST |
| Practice Address - Street 2: | |
| Practice Address - City: | CORAL GABLES |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33134-1604 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 305-774-3300 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-02 |
| Last Update Date: | 2015-10-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101Y00000X, 101YA0400X, 104100000X, 1041C0700X, 106H00000X, 163W00000X, 164W00000X, 207Q00000X, 2080A0000X, 2084P0800X, 2084P0804X, 363LP0808X, 376J00000X | ||
| FL | 1113AD777700 | 101YM0800X, 261QM0801X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty | |
| No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Single Specialty | |
| No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Single Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
| No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Single Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Single Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Single Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |
| No | 376J00000X | Nursing Service Related Providers | Homemaker | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 002340400 | Medicaid | |
| FL | 060305824 | Medicaid | |
| FL | 109574900 | Medicaid | |
| FL | 060305815 | Medicaid | |
| FL | 060305810 | Medicaid | |
| FL | 060305828 | Medicaid | |
| FL | 060305800 | Medicaid | |
| FL | 060305818 | Medicaid | |
| FL | 060305819 | Medicaid | |
| FL | 060305803 | Medicaid | |
| FL | 060305804 | Medicaid | |
| FL | 060305805 | Medicaid | |
| FL | 060305806 | Medicaid | |
| FL | 060305811 | Medicaid | |
| FL | 060305812 | Medicaid | |
| FL | 060305822 | Medicaid | |
| FL | 060305808 | Medicaid | |
| FL | 060305816 | Medicaid | |
| FL | 060305819 | Medicaid |
