Provider Demographics
NPI:1427385632
Name:DIGGS MIRACLE CARE OF VOLUSIA AND FLAGLER COUNTIES, INC.
Entity Type:Organization
Organization Name:DIGGS MIRACLE CARE OF VOLUSIA AND FLAGLER COUNTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-323-9855
Mailing Address - Street 1:875 DR MARY MCLEOD BETHUNE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3602
Mailing Address - Country:US
Mailing Address - Phone:386-323-9067
Mailing Address - Fax:
Practice Address - Street 1:875 DR MARY MCLEOD BETHUNE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3602
Practice Address - Country:US
Practice Address - Phone:386-323-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable