Organization
COMMUNITY LIFE DEV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YANTH BARRETO BA (TARGET CASE MANAGER)
(847) 707-9956
Entity
Organization
Contact information
Practice address
225 S SWOOPE AVE, MAITLAND, FL 32751-5704
(407) 790-4927
Mailing address
225 S SWOOPE AVE, MAITLAND, FL 32751-5704
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
593650750
—
FL
Enumeration date
01/26/2015
Last updated
01/26/2015
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