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2640 Hiawatha Ave Suite E Sanford FL 32773-5342 | |
| (407) 330-7373 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2640 Hiawatha Ave, Sanford, Florida |
| Authorized Official Name and Position | Tyrone Tyus (CEO/ CLINICAL DIRECTOR) |
| Authorized Official Contact | 3867381473 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2640 Hiawatha Ave Suite E Sanford FL 32773-5342 Ph: (407) 330-7373 | 2640 Hiawatha Ave Suite E Sanford FL 32773-5342 Ph: (407) 330-7373 |
| NPI Number | 1952721177 |
|---|---|
| Provider Enumeration Date | 04/28/2014 |
| Last Update Date | 04/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952721177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | DCF 1859AD523601 (Florida) | Primary |
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