Provider Demographics
NPI:1003130485
Name:UNITED CEREBRAL PALSY OF NORTHWEST FL
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF NORTHWEST FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ITDS
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-983-2551
Mailing Address - Street 1:4901 W FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4111
Mailing Address - Country:US
Mailing Address - Phone:850-983-2551
Mailing Address - Fax:
Practice Address - Street 1:4901 W FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4111
Practice Address - Country:US
Practice Address - Phone:850-983-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency