Healthcare Provider Details

I. General information

NPI: 1770876732
Provider Name (Legal Business Name): FOUNDATION OF THE PERSONAL EMPOWERMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 BLANDING BLVD STE 281
ORANGE PARK FL
32073-5039
US

IV. Provider business mailing address

661 BLANDING BLVD STE 281
ORANGE PARK FL
32073-5039
US

V. Phone/Fax

Practice location:
  • Phone: 904-444-1213
  • Fax: 904-269-2711
Mailing address:
  • Phone: 904-444-1213
  • Fax: 904-269-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. EVELYN D TUTEIN
Title or Position: CFO
Credential: MBA
Phone: 904-444-1213