Provider Demographics
NPI:1871203745
Name:CHILDGARDEN LLC
Entity type:Organization
Organization Name:CHILDGARDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-250-9854
Mailing Address - Street 1:3300 W 84TH ST UNIT 10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4909
Mailing Address - Country:US
Mailing Address - Phone:786-250-9854
Mailing Address - Fax:
Practice Address - Street 1:3300 W 84TH ST UNIT 10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4909
Practice Address - Country:US
Practice Address - Phone:786-250-9854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDGARDEN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109733000Medicaid