Organization
FDLRS/GATEWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL MILTON (PROJECT COORDINATOR)
(386) 792-2877
Entity
Organization
Contact information
Practice address
5683 US HIGHWAY 129 S, JASPER, FL 32052-6793
(386) 792-2877
Mailing address
5683 US HIGHWAY 129 S, JASPER, FL 32052-6793
(386) 792-2877
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
9188843
FL
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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