| Organization Name: | BRAIN DISORDER SUPPORT FOUNDATION, INC. |
| NPI Number: | 1558618454 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HILDA R COURSEY (ADMINISTRATOT) |
| Mailing Address: | 353 Juniper Lake Rd Defuniak Springs |
| State: | FL US |
| Postal Code: | 324333514 |
| Phone Number: | 8508920565 |
| Fax Number: | 8505204651 |
| NPI Enumeration Date: | 08/09/2012 |
| NPI Last Update Date: | 08/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | AHCA #9115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |