1225338502 NPI number — KATHLEEN ANDERSON COMPREHENSIVE WORK CENTER INC

Table of content: (NPI 1225338502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225338502 NPI number — KATHLEEN ANDERSON COMPREHENSIVE WORK CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN ANDERSON COMPREHENSIVE WORK 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:
SEMINOLE WORK OPPORTUNITY PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225338502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1095 BELLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-699-4419
Provider Business Mailing Address Fax Number:
407-699-7967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 BELLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASSELBERRY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32708-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-699-4419
Provider Business Practice Location Address Fax Number:
407-699-7967
Provider Enumeration Date:
11/02/2010

Additional Information

Authorized Official

Authorized Official Last Name:
POE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
HARRY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
407-699-4419

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  002 , 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)

  • Identifier: 024209898 . This is a "MED WAIVER PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024209896 . This is a "FLORIDA MED WAIVER PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com