Provider Demographics
NPI:1194342295
Name:FLORIDA BEHAVIORAL HEALTH PARTNERS LLC
Entity type:Organization
Organization Name:FLORIDA BEHAVIORAL HEALTH PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-823-7743
Mailing Address - Street 1:5280 SNAPFINGER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4044
Mailing Address - Country:US
Mailing Address - Phone:404-823-7743
Mailing Address - Fax:
Practice Address - Street 1:848 BRICKELL AVE PH 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3180
Practice Address - Country:US
Practice Address - Phone:786-730-6017
Practice Address - Fax:786-730-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health