NPIMap

Organization Active NPI

Homestead Behavioral Clinic, Inc.

  • Community/Behavioral Health Agency
  • Homestead, FL
National Provider Identifier
1285662841
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
HCC4181 Issued in FL
Legal business name
HOMESTEAD BEHAVIORAL CLINIC, INC.
Practice address
654 NE 9TH PL
Homestead, FL 33030-4934
Phone
(305) 248-3488
Fax
(305) 248-6558
NPI assigned
Jun 30, 2006
Last updated
Sep 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aidelyn Lopez
Title
Ceo
Phone
(305) 248-3488

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Adult Day Care Clinic/Center 261QA0600X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X HCC4181 FL
Mental Health Counselor 101YM0800X HCC 4035 FL
Behavior Analyst 103K00000X NU
Community/Behavioral Health Agency 251S00000X HCC4181 FL Primary

Addresses

Primary practice location

654 NE 9TH PL
Homestead, FL 33030-4934

Mailing address

654 NE 9TH PL
Homestead, FL 33030-4934
Phone (305) 248-3488

Other identifiers 5

IdentifierTypeStateIssuer
260257100MedicaidFL
678856400MedicaidFL
002005600MedicaidFL
000350100MedicaidFL
018520000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000707 FL Part B Supplier - Clinic/Group Practice 4082507249 Receives reassigned benefits from 16 practitioners
Practice locations: Homestead, FL

National Provider Directory

National Provider Directory

Locations

1 N Krome Ave
Homestead, FL 33030

654 NE 9th Pl
Homestead, FL 33030
Phone (305) 247-2884

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1285662841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 NE 9TH PL",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330304934",
            "telephone_number": "305-248-3488",
            "fax_number": "305-248-6558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 NE 9TH PL",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330304934",
            "telephone_number": "305-248-3488",
            "fax_number": "305-248-6558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMESTEAD BEHAVIORAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2021-09-29",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "AIDELYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-248-3488"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "HCC4181",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "HCC 4035",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "HCC4181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260257100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "678856400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002005600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000350100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018520000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homestead, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.