| Blossom Behavior Center Llc | |
|
13706 Sw 56th St Ste 105-106 Miami FL 33175-6036 | |
| (786) 688-2630 | |
| (786) 513-8495 |
| Full Name | Blossom Behavior Center Llc |
|---|---|
| Speciality | Case Management |
| Location | 13706 Sw 56th St Ste 105-106, Miami, Florida |
| Authorized Official Name and Position | Lisdeybys Batlle Lorente (PRESIDENT) |
| Authorized Official Contact | 7865234289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Behavior Center Llc 13706 Sw 56th St Ste 105-106 Miami FL 33175-6036 Ph: (786) 688-2630 | Blossom Behavior Center Llc 13706 Sw 56th St Ste 105-106 Miami FL 33175-6036 Ph: (786) 688-2630 |
| NPI Number | 1174153449 |
|---|---|
| Provider Enumeration Date | 01/24/2020 |
| Last Update Date | 11/01/2022 |
| Certification Date | 11/01/2022 |
| Medicare PECOS PAC ID | 9739501966 |
|---|---|
| Medicare Enrollment ID | O20200617000881 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174153449 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Carlos Larrauri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538668298 PECOS PAC ID: 7113261264 Enrollment ID: I20181130001687 |
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