| Homestead Behavioral Clinic, Inc. | |
|
654 Ne 9th Pl Homestead FL 33030-4934 | |
| (305) 248-3488 | |
| (305) 248-6558 |
| Full Name | Homestead Behavioral Clinic, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 654 Ne 9th Pl, Homestead, Florida |
| Authorized Official Name and Position | Aidelyn Lopez (CEO) |
| Authorized Official Contact | 3052483488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Homestead Behavioral Clinic, Inc. 654 Ne 9th Pl Homestead FL 33030-4934 Ph: (305) 248-3488 | Homestead Behavioral Clinic, Inc. 654 Ne 9th Pl Homestead FL 33030-4934 Ph: (305) 248-3488 |
| NPI Number | 1285662841 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 09/29/2021 |
| Certification Date | 08/05/2021 |
| Medicare PECOS PAC ID | 4082507249 |
|---|---|
| Medicare Enrollment ID | O20040203000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285662841 | NPI | - | NPPES |
| 260257100 | Medicaid | FL | |
| 678856400 | Medicaid | FL | |
| 000350100 | Medicaid | FL | |
| 002005600 | Medicaid | FL | |
| 018520000 | Medicaid | FL |
| Provider Name | Jose C Lopez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669515730 PECOS PAC ID: 8325959117 Enrollment ID: I20031113000680 |
| Provider Name | Carlos A Ripoll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558751099 PECOS PAC ID: 7214034404 Enrollment ID: I20151014001048 |
| Provider Name | Nelson Andino Rios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851760060 PECOS PAC ID: 3072801257 Enrollment ID: I20161004002727 |
| Provider Name | Katheryn Fernandez Paul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902116007 PECOS PAC ID: 5294165866 Enrollment ID: I20200422001219 |
| Provider Name | Jacqueline Iriarte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528539764 PECOS PAC ID: 0840612065 Enrollment ID: I20200617000293 |
| Provider Name | Jason Lopez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659802916 PECOS PAC ID: 9335549518 Enrollment ID: I20210609001412 |
| Provider Name | Elvira G Maqueira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932514932 PECOS PAC ID: 3072914498 Enrollment ID: I20210623001319 |
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