=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043537418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYNES & MCMILLIAN EDUCATIONAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2010
-----------------------------------------------------
Last Update Date | 04/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1635 RIDGEWOOD AVE SUITE 209
-----------------------------------------------------
City | SOUTH DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-307-0441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1635 RIDGEWOOD AVE SUITE 209
-----------------------------------------------------
City | SOUTH DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-307-0441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | MS. BELINDA MARIE MCMILLIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-307-0441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------