Provider Demographics
NPI:1376144337
Name:FLOURISH LIKE FOLIAGE, INC.
Entity Type:Organization
Organization Name:FLOURISH LIKE FOLIAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ILBOUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-218-8345
Mailing Address - Street 1:15732 JOHN DISKIN CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6550
Mailing Address - Country:US
Mailing Address - Phone:310-218-8345
Mailing Address - Fax:
Practice Address - Street 1:15732 JOHN DISKIN CIR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6550
Practice Address - Country:US
Practice Address - Phone:310-218-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty