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General NPI Number Information
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NPI Number | 1154503647
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Entity Type | Organization
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Legal Business Name | THE DANIEL M. FOUNDATION, INC.
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 309 S 7TH ST
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City | FORT PIERCE
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State | FL
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Zip | 34950-4228
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Country | US
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Telephone | 772-426-0194
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Fax |
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Provider Business Mailing Address
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Address Line | 827 SUNRISE BLVD
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City | FORT PIERCE
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State | FL
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Zip | 34950-5045
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Country | US
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Telephone | 772-426-0194
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LINDA STEVENS MELTON
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Credential |
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Telephone | 772-426-0194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | C15SL0110
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License Number State | FL
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