Organization
ALINA COMMUNITY CENTER AT MOUNT DORA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRAVIL JOSEPH PMHNP-BC (CEO)
(954) 392-3000
Entity
Organization
Contact information
Practice address
4601 N HIGHWAY 19A, MOUNT DORA, FL 32757-2039
(352) 602-7924
(352) 602-4952
Mailing address
4601 N HIGHWAY 19A, MOUNT DORA, FL 32757-2039
(352) 602-7924
(352) 602-4952
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106393700
—
FL
Enumeration date
08/12/2020
Last updated
08/12/2020
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