Organization
FLORIDA MENTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD DEMETRICE MONAGAN (ADMINISTRATOR)
(386) 274-4172
Entity
Organization
Contact information
Practice address
1725 5TH STREET, DAYTONA BEACH, FL 32117-5107
(386) 274-4172
(386) 274-5568
Mailing address
1725 FIFTH ST, DAYTONA BEACH, FL 32117-5107
(386) 274-4172
(386) 274-5568
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
03125760
FL
Other
Enumeration date
12/28/2006
Last updated
08/22/2020
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