Healthcare Provider Details

I. General information

NPI: 1922694918
Provider Name (Legal Business Name): ASHLEY MARIE HEGLAND FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

IV. Provider business mailing address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-9558
  • Fax:
Mailing address:
  • Phone: 561-704-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL SASSON
Title or Position: CHAIRMAN
Credential:
Phone: 561-704-9558