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Organization
PHOENIX HOUSE OF SUPPORT CORP
Active
Organization
PHOENIX HOUSE OF SUPPORT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA VIQUILLON (OWNER)
(786) 301-1571
Entity
Organization
Contact information
Practice address
8902 SW 208TH TER, CUTLER BAY, FL 33189-3884
(786) 301-1571
(305) 233-8594
Mailing address
8902 SW 208TH TER, CUTLER BAY, FL 33189-3884
(786) 301-1571
(305) 233-8594
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
016029700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016029700
—
FL
Enumeration date
08/30/2016
Last updated
08/30/2016
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