Provider Demographics
NPI:1801602594
Name:HOMESTEAD BEHAVIORAL CARE CORP
Entity type:Organization
Organization Name:HOMESTEAD BEHAVIORAL CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:305-283-3025
Mailing Address - Street 1:2500 NW 79TH AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1090
Mailing Address - Country:US
Mailing Address - Phone:786-803-8488
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 290
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1090
Practice Address - Country:US
Practice Address - Phone:786-803-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty