Provider Demographics
NPI:1104124940
Name:BUTTERFLY EFFECTS
Entity type:Organization
Organization Name:BUTTERFLY EFFECTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BACBA
Authorized Official - Prefix:
Authorized Official - First Name:LUCNER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-318-1252
Mailing Address - Street 1:2708 NE 14TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3564
Mailing Address - Country:US
Mailing Address - Phone:954-603-7885
Mailing Address - Fax:954-342-0273
Practice Address - Street 1:2708 NE 14TH ST APT 5
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3564
Practice Address - Country:US
Practice Address - Phone:954-603-7885
Practice Address - Fax:954-342-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities