Provider Demographics
NPI:1558983379
Name:MAGNIFICO INDUSTRIES LLC
Entity Type:Organization
Organization Name:MAGNIFICO INDUSTRIES LLC
Other - Org Name:INNOVATIVE BEHAVIOR TECHNOLOGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:559-871-4749
Mailing Address - Street 1:1280 GRAND MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2879
Mailing Address - Country:US
Mailing Address - Phone:559-871-4749
Mailing Address - Fax:
Practice Address - Street 1:1280 GRAND MEADOW WAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-2879
Practice Address - Country:US
Practice Address - Phone:559-871-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty