Provider Demographics
NPI:1457792012
Name:COMMUNITY ADVANCEMENT DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:COMMUNITY ADVANCEMENT DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:321-278-4832
Mailing Address - Street 1:128 W BROADWAY ST
Mailing Address - Street 2:STE 106
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:321-287-4832
Mailing Address - Fax:
Practice Address - Street 1:128 W BROADWAY ST
Practice Address - Street 2:STE 106
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:321-287-4832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty