Provider Demographics
NPI:1972153468
Name:ANDERSON DOVILAS FOUNDATION, INC
Entity type:Organization
Organization Name:ANDERSON DOVILAS FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOIVLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-732-1360
Mailing Address - Street 1:1170 POST LAKE PL APT 108
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8607
Mailing Address - Country:US
Mailing Address - Phone:407-723-3921
Mailing Address - Fax:
Practice Address - Street 1:1170 POST LAKE PL APT 108
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-8607
Practice Address - Country:US
Practice Address - Phone:407-723-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000000OtherTRANSPORTATION