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General NPI Number Information
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NPI Number | 1497084040
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Entity Type | Organization
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Legal Business Name | ANGELWOOD, INC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 4674-2 HOOD RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1114
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Country | US
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Telephone | 904-288-7259
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Fax | 904-288-7260
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Provider Business Mailing Address
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Address Line | PO BOX 24925
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City | JACKSONVILLE
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State | FL
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Zip | 32241-4925
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Country | US
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Telephone | 904-288-7259
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Fax | 904-288-7260
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DIANE TUTTLE
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Credential |
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Telephone | 904-288-7259
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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 | 1-09-5888
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License Number State | FL
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