Provider Demographics
NPI:1982149449
Name:MAXI BEHAVIOR SUPPORT
Entity Type:Organization
Organization Name:MAXI BEHAVIOR SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAXI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-577-0632
Mailing Address - Street 1:6713 HERITAGE GRANDE UNIT 1206
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7913
Mailing Address - Country:US
Mailing Address - Phone:561-577-0632
Mailing Address - Fax:
Practice Address - Street 1:6713 HERITAGE GRANDE UNIT 1206
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-7913
Practice Address - Country:US
Practice Address - Phone:561-577-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service