Provider Demographics
NPI:1578728770
Name:MCCLUSKY ENTERPRISES INC.
Entity Type:Organization
Organization Name:MCCLUSKY ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCLUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:813-653-4072
Mailing Address - Street 1:110-B LITHIA PINECREST ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5300
Mailing Address - Country:US
Mailing Address - Phone:813-653-4072
Mailing Address - Fax:813-661-4456
Practice Address - Street 1:110B LITHIA PINECREST RD STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5306
Practice Address - Country:US
Practice Address - Phone:813-653-4072
Practice Address - Fax:813-661-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL671327196Medicaid