| NPI | 1245416577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL MICHAEL UKPONG President 772-446-0389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: FL N05000007078) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: FL N05000007078) |
| 302F00000X Exclusive Provider Organization (Licence: FL N05000007078) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL N05000007078) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: FL N05000007078) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL N05000007078) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-01-16 |