Basic Information
| Provider Information | |||||||||
| NPI: | 1760121917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A SUNNY DAY DEVELOPMENT CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1458 CENTRAL PKWY | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325639103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507776764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1458 CENTRAL PKWY | ||||||||
| Address2: | |||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325639103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507776764 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | FLAKE | ||||||||
| AuthorizedOfficialFirstName: | MARTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8507776764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
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.