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NPI 1235019613 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Daytona Beach, FL
Provider details
- NPI number
- 1235019613
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Corinda Goff, Admin(321) 295-1695
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(54/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
331 Fulton St
Daytona Beach, FL 32114-3021
Phone: (321) 295-1695
Street-level locationGet directions
Mailing address
271 Cherokee Hill Ct
Deland, FL 32724-7827
Registry dates
- Enumerated
- 2025-09-05
- Last updated
- 2025-09-05
- Certified
- 2025-09-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.