Provider Demographics
NPI:1265672927
Name:BIG CYPRESS WILDERNESS INSTITUTE
Entity Type:Organization
Organization Name:BIG CYPRESS WILDERNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-695-1001
Mailing Address - Street 1:25959 TURNER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OCHOPEE
Mailing Address - State:FL
Mailing Address - Zip Code:34141-2031
Mailing Address - Country:US
Mailing Address - Phone:239-695-1001
Mailing Address - Fax:239-695-1004
Practice Address - Street 1:25959 TURNER RIVER RD
Practice Address - Street 2:
Practice Address - City:OCHOPEE
Practice Address - State:FL
Practice Address - Zip Code:34141-2031
Practice Address - Country:US
Practice Address - Phone:239-695-1001
Practice Address - Fax:239-695-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED MARINE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health