Healthcare Provider Details

I. General information

NPI: 1235671421
Provider Name (Legal Business Name): PROJECT D.A.L.E. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2016
Last Update Date: 11/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 RINGLING BLVD #2631
SARASOTA FL
34230-7000
US

IV. Provider business mailing address

PO BOX 2631
SARASOTA FL
34230-2631
US

V. Phone/Fax

Practice location:
  • Phone: 941-404-8382
  • Fax: 248-769-6154
Mailing address:
  • Phone: 941-404-8382
  • Fax: 248-769-6154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WALLACE DASHER III
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential: M.S.
Phone: 941-404-8382