Provider Demographics
NPI:1831295732
Name:COMMUNITY BASED CARE OF VOLUSIA AND FLAGLER COUNTIES, INC.
Entity Type:Organization
Organization Name:COMMUNITY BASED CARE OF VOLUSIA AND FLAGLER COUNTIES, INC.
Other - Org Name:PCBC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZYCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-238-4900
Mailing Address - Street 1:160 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3314
Mailing Address - Country:US
Mailing Address - Phone:386-238-4900
Mailing Address - Fax:
Practice Address - Street 1:160 N BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3314
Practice Address - Country:US
Practice Address - Phone:386-238-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN NUMBER