Basic Information
| Provider Information | |||||||||
| NPI: | 1285307066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL FOUNDATION CENTERS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 179 RABBIT RUN | ||||||||
| Address2: | |||||||||
| City: | OSTEEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327649461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868433006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 S RIDGEWOOD AVE STE 32 | ||||||||
| Address2: | |||||||||
| City: | SOUTH DAYTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321193073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048788683 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2021 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | SALLADE | ||||||||
| AuthorizedOfficialFirstName: | MARRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9048788683 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIORAL FOUNDATION CENTERS INC | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.