Organization
ACT CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THEA ANN SALIERNO BS (PROGRAM SUPERVISOR)
(386) 416-1021
Entity
Organization
Contact information
Practice address
1220 WILLIS AVE, DAYTONA BEACH, FL 32114-2810
(386) 416-1021
Mailing address
1220 WILLIS AVE, DAYTONA BEACH, FL 32114-2810
(386) 416-1021
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
758375300
—
FM
Enumeration date
01/30/2006
Last updated
09/06/2023
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