| Phoenix House Of Support Corp | |
|
8902 Sw 208th Ter Cutler Bay FL 33189-3884 | |
| (786) 301-1571 | |
| (305) 233-8594 |
| Full Name | Phoenix House Of Support Corp |
|---|---|
| Speciality | Behavior Analyst |
| Location | 8902 Sw 208th Ter, Cutler Bay, Florida |
| Authorized Official Name and Position | Tamara Viquillon (OWNER) |
| Authorized Official Contact | 7863011571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix House Of Support Corp 8902 Sw 208th Ter Cutler Bay FL 33189-3884 Ph: (786) 301-1571 | Phoenix House Of Support Corp 8902 Sw 208th Ter Cutler Bay FL 33189-3884 Ph: (786) 301-1571 |
| NPI Number | 1356897300 |
|---|---|
| Provider Enumeration Date | 08/30/2016 |
| Last Update Date | 08/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356897300 | NPI | - | NPPES |
| 016029700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 016029700 (Florida) | Primary |
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