Healthcare Provider Details

I. General information

NPI: 1619644069
Provider Name (Legal Business Name): BEYOND EXPECTATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S FERDON BLVD STE B3
CRESTVIEW FL
32536-5287
US

IV. Provider business mailing address

4100 S FERDON BLVD STE B3
CRESTVIEW FL
32536-5287
US

V. Phone/Fax

Practice location:
  • Phone: 850-362-6824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN THOMAS
Title or Position: CREDENTIALER/BILLER
Credential:
Phone: 201-241-0079