Organization
FLORIDA LIONS CONKLIN CTRS FOR THE BLIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT T KELLY CRC (EXECUTIVE DIRECTOR)
(386) 258-3441
Entity
Organization
Contact information
Practice address
405 WHITE ST, DAYTONA BEACH, FL 32114-2925
(386) 258-3441
(386) 258-1155
Mailing address
405 WHITE ST, DAYTONA BEACH, FL 32114-2925
(386) 258-3441
(386) 258-1155
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099870202
—
FL
05
—
673361196
—
FL
Enumeration date
06/04/2013
Last updated
06/04/2013
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