Healthcare Provider Details

I. General information

NPI: 1376189423
Provider Name (Legal Business Name): DREAM BIGGER CHILDREN'S FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 ALTERNATE A1A STE 402
PALM BEACH GARDENS FL
33410-4934
US

IV. Provider business mailing address

9840 ALTERNATE A1A STE 402
PALM BEACH GARDENS FL
33410-4934
US

V. Phone/Fax

Practice location:
  • Phone: 561-291-8437
  • Fax: 561-584-6785
Mailing address:
  • Phone: 561-291-8437
  • Fax: 561-584-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL A MAALE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 561-291-8437