Provider Demographics
NPI:1649424367
Name:1 VILLAGE 1 CHILD
Entity Type:Organization
Organization Name:1 VILLAGE 1 CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-356-9352
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0364
Mailing Address - Country:US
Mailing Address - Phone:321-356-9352
Mailing Address - Fax:407-880-3034
Practice Address - Street 1:2704 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2994
Practice Address - Country:US
Practice Address - Phone:321-356-9352
Practice Address - Fax:407-880-3034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable