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General NPI Number Information
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NPI Number | 1396620233
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Entity Type | Organization
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Legal Business Name | HERCULES ABA CLUBHOUSE LLC
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 6 POINBURY DR
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City | PALM COAST
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State | FL
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Zip | 32164-6773
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Country | US
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Telephone | 386-293-2499
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Fax |
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Provider Business Mailing Address
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Address Line | 6 POINBURY DR
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City | PALM COAST
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State | FL
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Zip | 32164-6773
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Country | US
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Telephone | 386-293-2499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAVIER EDWODO MOORE
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Credential | RBT
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Telephone | 386-293-2499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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