Individual
KIM CHANCELLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13052 COMPTON RD, LOXAHATCHEE, FL 33470-4714
(561) 797-7202
(561) 795-3014
Mailing address
13052 COMPTON RD, LOXAHATCHEE, FL 33470-4714
(561) 797-7202
(561) 795-3014
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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