Provider Demographics
NPI:1285473033
Name:AVID BEHAVIOR CARE
Entity type:Organization
Organization Name:AVID BEHAVIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDRICH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-479-0652
Mailing Address - Street 1:1908 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-1123
Mailing Address - Country:US
Mailing Address - Phone:786-479-0652
Mailing Address - Fax:
Practice Address - Street 1:1908 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-1123
Practice Address - Country:US
Practice Address - Phone:786-479-0652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty