Provider Demographics
NPI:1982125373
Name:MIRACLE BEHAVIOR CORP
Entity Type:Organization
Organization Name:MIRACLE BEHAVIOR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-558-4091
Mailing Address - Street 1:12905 BIRD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2910
Mailing Address - Country:US
Mailing Address - Phone:786-558-4091
Mailing Address - Fax:
Practice Address - Street 1:12905 BIRD RD STE 111
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2910
Practice Address - Country:US
Practice Address - Phone:786-558-4091
Practice Address - Fax:786-254-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty