Organization
INTENTIONAL PROVISIONS OUTREACH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANDRA P MALLARY (OWNER/DIRECT CARE)
(786) 239-3081
Entity
Organization
Contact information
Practice address
1799 SW 8TH ST, HOMESTEAD, FL 33030-6621
(786) 239-3081
Mailing address
1799 SW 8TH ST, HOMESTEAD, FL 33030-6621
(786) 239-3081
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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