Organization
MOCKINGBIRD QUALITY CARE BEHAVIOR FOCUS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMION S PETERS (WAIVER PROVIDER)
(631) 796-1567
Entity
Organization
Contact information
Practice address
5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517
(831) 796-1567
Mailing address
5921 RIVA RIDGE DR, WESLEY CHAPEL, FL 33544-6517
(831) 796-1567
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017344800
—
FL
Enumeration date
02/09/2022
Last updated
02/09/2022
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