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600 N Broadway Ave Ste 305 Bartow FL 33830-3807 | |
| (863) 385-1009 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 600 N Broadway Ave Ste 305, Bartow, Florida |
| Authorized Official Name and Position | Felicia Patterson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8633851009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4343 Sun N Lake Blvd Sebring FL 33872-2162 Ph: (863) 385-1009 | 600 N Broadway Ave Ste 305 Bartow FL 33830-3807 Ph: (863) 385-1009 |
| NPI Number | 1508481979 |
|---|---|
| Provider Enumeration Date | 06/11/2020 |
| Last Update Date | 08/08/2024 |
| Certification Date | 08/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508481979 | NPI | - | NPPES |
| 102208700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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