| Stallworth Community Services Inc | |
|
304 26th Avenue East Bradenton FL 34208 | |
| (941) 536-4449 | |
| (941) 355-8699 |
| Full Name | Stallworth Community Services Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 304 26th Avenue East, Bradenton, Florida |
| Authorized Official Name and Position | Janell Latrice Stallworth (PRESIDENT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9415364449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stallworth Community Services Inc Po Box 57 Tallevast FL 34270 Ph: (941) 536-4449 | Stallworth Community Services Inc 304 26th Avenue East Bradenton FL 34208 Ph: (941) 536-4449 |
| NPI Number | 1265690366 |
|---|---|
| Provider Enumeration Date | 05/27/2008 |
| Last Update Date | 05/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265690366 | NPI | - | NPPES |
| 690209096 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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