Provider Demographics
NPI:1689170409
Name:BEHAVIORAL FOUNDATION CENTERS INC
Entity Type:Organization
Organization Name:BEHAVIORAL FOUNDATION CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARRIE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:SALLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:386-843-3006
Mailing Address - Street 1:179 RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:OSTEEN
Mailing Address - State:FL
Mailing Address - Zip Code:32764-9461
Mailing Address - Country:US
Mailing Address - Phone:386-843-3006
Mailing Address - Fax:
Practice Address - Street 1:537 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8017
Practice Address - Country:US
Practice Address - Phone:904-878-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-9657103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty