Provider Demographics
NPI:1801293626
Name:INTUITIVE NETWORKING
Entity type:Organization
Organization Name:INTUITIVE NETWORKING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/BUSINESS DEVELOPMENT MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:386-453-4807
Mailing Address - Street 1:110 E GRANADA BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6603
Mailing Address - Country:US
Mailing Address - Phone:386-256-1492
Mailing Address - Fax:386-753-3622
Practice Address - Street 1:110 E GRANADA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6603
Practice Address - Country:US
Practice Address - Phone:386-256-1492
Practice Address - Fax:386-753-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL010579300171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010579300Medicaid
FL010579600Medicaid