Organization
STANDUP POLK
Active
Organization
STANDUP POLK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA ELLISON (EXECUTIVE DIRECTOR)
(863) 802-0777
Entity
Organization
Contact information
Practice address
621 S FLORIDA AVE, LAKELAND, FL 33801-5230
(863) 802-0777
(863) 802-0065
Mailing address
621 S FLORIDA AVE, LAKELAND, FL 33801-5230
(863) 802-0777
(863) 802-0065
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/10/2013
Last updated
06/10/2013
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