Organization
BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OHILDA SANCHEZ (AUTHORIZED OFFICAL)
(786) 470-9404
Entity
Organization
Contact information
Practice address
306 S 10TH ST STE 340, HAINES CITY, FL 33844-5602
(786) 470-9404
Mailing address
306 S 10TH ST STE 340, HAINES CITY, FL 33844-5602
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE
ACN1250
FL
Enumeration date
06/16/2021
Last updated
06/17/2021
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