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35201 Radio Rd Leesburg FL 34788-3148 | |
| (352) 787-3079 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 35201 Radio Rd, Leesburg, Florida |
| Authorized Official Name and Position | Mark A Swain (CEO) |
| Authorized Official Contact | 3527873079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
35201 Radio Rd Leesburg FL 34788-3148 Ph: (352) 787-3079 | 35201 Radio Rd Leesburg FL 34788-3148 Ph: (352) 787-3079 |
| NPI Number | 1386049203 |
|---|---|
| Provider Enumeration Date | 11/04/2014 |
| Last Update Date | 11/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386049203 | NPI | - | NPPES |
| 023829596 | Other | FL | MEDICAID WAIVER PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Florida) | Primary |
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