Healthcare Provider Details

I. General information

NPI: 1639278377
Provider Name (Legal Business Name): HUMAN DEVELOPMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 N TAMPA ST
TAMPA FL
33603-4743
US

IV. Provider business mailing address

5904 N ARMENIA AVE
TAMPA FL
33603-1024
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-6250
  • Fax: 813-872-6078
Mailing address:
  • Phone: 813-872-6250
  • Fax: 813-872-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CHURCH
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D., BCBA-D
Phone: 813-872-6250