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3206 Hillsdale Ln Kissimmee FL 34741-7562 | |
| (407) 530-5911 | |
| (888) 216-6045 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3206 Hillsdale Ln, Kissimmee, Florida |
| Authorized Official Name and Position | Melody L Kipp (PRESIDENT/CEO) |
| Authorized Official Contact | 4075305911 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3206 Hillsdale Ln Kissimmee FL 34741-7562 Ph: (407) 530-5911 | 3206 Hillsdale Ln Kissimmee FL 34741-7562 Ph: (407) 530-5911 |
| NPI Number | 1023287901 |
|---|---|
| Provider Enumeration Date | 02/26/2008 |
| Last Update Date | 11/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023287901 | NPI | - | NPPES |
| 003467600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH5173 (Florida) | Primary |
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