1700983426 NPI number — JENNINGS' APPLIED BEHAVIOR & COGNITIVE CENTER, INC.

Table of content: (NPI 1700983426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700983426 NPI number — JENNINGS' APPLIED BEHAVIOR & COGNITIVE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNINGS' APPLIED BEHAVIOR & COGNITIVE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1700983426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 S PATRICK DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SATELLITE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32937-3963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-779-0213
Provider Business Mailing Address Fax Number:
321-773-0497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1275 S PATRICK DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SATELLITE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32937-3963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-779-0213
Provider Business Practice Location Address Fax Number:
321-773-0497
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENNINGS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
321-779-0213

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH7350 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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