Organization
PATH TO PROGRESSIVE HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWDY ENID MATIAS (PRESIDENT)
(321) 805-0282
Entity
Organization
Contact information
Practice address
4174 CORSAIR AVE, KISSIMMEE, FL 34741-2949
(321) 805-0282
Mailing address
PO BOX 700584, SAINT CLOUD, FL 34770-0584
(321) 805-2802
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13568687717
—
FL
Enumeration date
08/17/2017
Last updated
07/21/2022
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