Provider Demographics
NPI:1720267750
Name:BASIC NWFI INC
Entity type:Organization
Organization Name:BASIC NWFI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MINCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:850-785-1088
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:423 MAGNOLIA AVE
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401
Mailing Address - Country:US
Mailing Address - Phone:850-785-1088
Mailing Address - Fax:850-785-8111
Practice Address - Street 1:423 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-785-1088
Practice Address - Fax:850-785-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty