| NPI | 1982061537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD R BRANTLEY Director 407-236-6583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH970) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL 5848) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-26 |