Shalanda's House Inc | |
715 Almond Street Suite A Clermont FL 34711 | |
(352) 931-1042 | |
Not Available |
Full Name | Shalanda's House Inc |
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Speciality | Community/Behavioral Health |
Location | 715 Almond Street Suite A, Clermont, Florida |
Authorized Official Name and Position | Kimberly Smith (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3529311042 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shalanda's House Inc 715 Almond Street Suite A Clermont FL 34711 Ph: (352) 931-1042 | Shalanda's House Inc 715 Almond Street Suite A Clermont FL 34711 Ph: (352) 931-1042 |
NPI Number | 1235815150 |
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Provider Enumeration Date | 06/26/2023 |
Last Update Date | 10/24/2023 |
Certification Date | 10/24/2023 |
Medicare PECOS PAC ID | 5890131312 |
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Medicare Enrollment ID | O20240306004465 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235815150 | NPI | - | NPPES |
Provider Name | Kimberly L Smith |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1578814166 PECOS PAC ID: 1557501335 Enrollment ID: I20130628000599 |
Provider Name | Nakei Tameka Wright Powell |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1306199781 PECOS PAC ID: 1153761267 Enrollment ID: I20240506001884 |
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