Provider Demographics
NPI:1720865587
Name:SHIELDS FOUNDATION FL, LLC
Entity Type:Organization
Organization Name:SHIELDS FOUNDATION FL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-353-9132
Mailing Address - Street 1:3114 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6438
Mailing Address - Country:US
Mailing Address - Phone:772-353-9132
Mailing Address - Fax:
Practice Address - Street 1:3114 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-6438
Practice Address - Country:US
Practice Address - Phone:772-353-9132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services