Provider Demographics
NPI:1194525139
Name:OUTSIDE THE BOX DEVELOPMENTAL CENTER
Entity type:Organization
Organization Name:OUTSIDE THE BOX DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANBACK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:267-574-2457
Mailing Address - Street 1:4701 N FEDERAL HWY STE 460
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6591
Mailing Address - Country:US
Mailing Address - Phone:267-574-2457
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY STE 460
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6591
Practice Address - Country:US
Practice Address - Phone:267-574-2457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child