Organization
M&D RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENSIL A REYNOLDS (PRESIDENT)
(772) 807-1250
Entity
Organization
Contact information
Practice address
2556 SW MONTERREY LN, PORT ST LUCIE, FL 34953-2956
(772) 807-1205
Mailing address
2556 SW MONTERREY LN, PORT ST LUCIE, FL 34953-2956
(772) 807-1205
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
151446
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
686560796
—
FL
Enumeration date
11/08/2010
Last updated
11/08/2010
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