Provider Demographics
NPI:1649714536
Name:SPRINGVIEW ACADEMY INC
Entity type:Organization
Organization Name:SPRINGVIEW ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-5207
Mailing Address - Street 1:18505 NW 75 PL
Mailing Address - Street 2:SUITE 127
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18505 NW 75TH PL
Practice Address - Street 2:SUITE 127
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2961
Practice Address - Country:US
Practice Address - Phone:305-456-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid