Mockingbird Quality Care Behavior Focus, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MOCKINGBIRD QUALITY CARE BEHAVIOR FOCUS, LLC

Practice address

5921 Riva Ridge Dr
Wesley Chapel, FL 33544-6517

Phone

(831) 796-1567

NPI assigned

Feb 9, 2022

Organization subpart

No

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

Authorized official

Name

Damion S Peters

Title

Waiver Provider

Phone

(631) 796-1567

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1356095202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5921 RIVA RIDGE DR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335446517",
            "telephone_number": "831-796-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5921 RIVA RIDGE DR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335446517",
            "telephone_number": "831-796-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOCKINGBIRD QUALITY CARE BEHAVIOR FOCUS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "DAMION",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "WAIVER PROVIDER",
        "authorized_official_telephone_number": "631-796-1567"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017344800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.