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Organization

GO CHECKPOINT

Active
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Organization

GO CHECKPOINT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANITHRA MINUS (CEO)
(772) 925-9435
Entity
Organization

Contact information

Practice address
5203 LA SALLE ST APT A, FORT PIERCE, FL 34951-5029
(772) 925-9435
Mailing address
5203 LA SALLE ST APT A, FORT PIERCE, FL 34951-5029

Taxonomy

Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary

Other

Enumeration date
08/17/2017
Last updated
08/17/2017
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