Provider Demographics
NPI:1518516046
Name:DEVELOPING ASSISTANCE TO A VAST INNOVATIVE SOCIETY COMMUNITY DEVELOPME
Entity Type:Organization
Organization Name:DEVELOPING ASSISTANCE TO A VAST INNOVATIVE SOCIETY COMMUNITY DEVELOPME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENE
Authorized Official - Middle Name:ALISHA
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-669-0209
Mailing Address - Street 1:1780 NW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4128
Mailing Address - Country:US
Mailing Address - Phone:954-669-0209
Mailing Address - Fax:
Practice Address - Street 1:1780 NW 36TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33311-4128
Practice Address - Country:US
Practice Address - Phone:954-669-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No273Y00000XHospital UnitsRehabilitation Unit
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEOtherNONE
FL812381689OtherIRS