Provider Demographics
NPI:1649466806
Name:EXCEPTIONAL DEVELOPMENT CORP. OF SOUTH FLORIDA
Entity type:Organization
Organization Name:EXCEPTIONAL DEVELOPMENT CORP. OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-758-9910
Mailing Address - Street 1:991 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-1817
Mailing Address - Country:US
Mailing Address - Phone:305-758-9910
Mailing Address - Fax:305-758-9929
Practice Address - Street 1:991 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-1817
Practice Address - Country:US
Practice Address - Phone:305-758-9910
Practice Address - Fax:305-758-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)