Healthcare Provider Details

I. General information

NPI: 1942536941
Provider Name (Legal Business Name): THERAPEUTIC FOUNDATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 DAL MASO DR
DAYTONA BEACH FL
32117-4109
US

IV. Provider business mailing address

1181 DAL MASO DR
DAYTONA BEACH FL
32117-4109
US

V. Phone/Fax

Practice location:
  • Phone: 386-846-3351
  • Fax: 386-226-2076
Mailing address:
  • Phone: 386-846-3351
  • Fax: 386-226-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number686174196
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number686174196
License Number StateFL

VIII. Authorized Official

Name: MS. DAWN LOUISE NAIMOLI
Title or Position: CEO
Credential: MA, BCBA
Phone: 386-846-3351