Provider Demographics
NPI:1285307066
Name:BEHAVIORAL FOUNDATION CENTERS INC
Entity type:Organization
Organization Name:BEHAVIORAL FOUNDATION CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLADE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-878-8683
Mailing Address - Street 1:179 RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:OSTEEN
Mailing Address - State:FL
Mailing Address - Zip Code:32764-9461
Mailing Address - Country:US
Mailing Address - Phone:386-843-3006
Mailing Address - Fax:
Practice Address - Street 1:2400 S RIDGEWOOD AVE STE 32
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3073
Practice Address - Country:US
Practice Address - Phone:904-878-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL FOUNDATION CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty