Provider Demographics
NPI:1770876732
Name:FOUNDATION OF THE PERSONAL EMPOWERMENT CENTER
Entity type:Organization
Organization Name:FOUNDATION OF THE PERSONAL EMPOWERMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:904-444-1213
Mailing Address - Street 1:661 BLANDING BLVD STE 281
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5039
Mailing Address - Country:US
Mailing Address - Phone:904-444-1213
Mailing Address - Fax:904-269-2711
Practice Address - Street 1:661 BLANDING BLVD STE 281
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5039
Practice Address - Country:US
Practice Address - Phone:904-444-1213
Practice Address - Fax:904-269-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable