Provider Demographics
NPI:1033305032
Name:HENDERSON'S FOSTER CARE HOME, INC.
Entity Type:Organization
Organization Name:HENDERSON'S FOSTER CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:386-574-1570
Mailing Address - Street 1:2563 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8807
Mailing Address - Country:US
Mailing Address - Phone:386-574-1570
Mailing Address - Fax:386-574-1562
Practice Address - Street 1:2563 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-8807
Practice Address - Country:US
Practice Address - Phone:386-574-1570
Practice Address - Fax:386-574-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFOSTER CARE251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services