Provider Demographics
NPI:1861932782
Name:BA CHILDREN SUPPORT INC
Entity type:Organization
Organization Name:BA CHILDREN SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MERY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-1-17-28408
Authorized Official - Phone:786-712-3844
Mailing Address - Street 1:13352 SW 128TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5807
Mailing Address - Country:US
Mailing Address - Phone:786-592-2263
Mailing Address - Fax:786-272-0440
Practice Address - Street 1:13352 SW 128TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-592-2263
Practice Address - Fax:786-272-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020132600Medicaid