Healthcare Provider Details

I. General information

NPI: 1194525139
Provider Name (Legal Business Name): OUTSIDE THE BOX DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N FEDERAL HWY STE 460
POMPANO BEACH FL
33064-6591
US

IV. Provider business mailing address

4701 N FEDERAL HWY STE 460
POMPANO BEACH FL
33064-6591
US

V. Phone/Fax

Practice location:
  • Phone: 267-574-2457
  • Fax:
Mailing address:
  • Phone: 267-574-2457
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: NIKEDA STANBACK
Title or Position: CEO
Credential: BCBA
Phone: 267-574-2457