Provider Demographics
NPI:1871328047
Name:ISA BEHAVIORAL GROUP LLC
Entity type:Organization
Organization Name:ISA BEHAVIORAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-6224
Mailing Address - Street 1:18710 SW 107TH AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6774
Mailing Address - Country:US
Mailing Address - Phone:786-344-6224
Mailing Address - Fax:
Practice Address - Street 1:18710 SW 107TH AVE UNIT 16
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6774
Practice Address - Country:US
Practice Address - Phone:786-344-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty