Provider Demographics
NPI:1043537418
Name:HAYNES & MCMILLIAN EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:HAYNES & MCMILLIAN EDUCATIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-307-0441
Mailing Address - Street 1:1635 RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SOUTH DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-307-0441
Mailing Address - Fax:
Practice Address - Street 1:1635 RIDGEWOOD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SOUTH DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-307-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYNES & MCMILLIAN EDUCATIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM918114Medicaid