| Vince Carter Sanctuary | |
|
301 Justice Ln Bunnell FL 32110-4487 | |
| (800) 478-0331 | |
| (386) 236-3178 |
| Full Name | Vince Carter Sanctuary |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 301 Justice Ln, Bunnell, Florida |
| Authorized Official Name and Position | Ivan A Cosimi (CEO/PRESIDENT) |
| Authorized Official Contact | 3862361811 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vince Carter Sanctuary 150 Magnolia Ave Daytona Beach FL 32114-4304 Ph: (386) 236-3200 | Vince Carter Sanctuary 301 Justice Ln Bunnell FL 32110-4487 Ph: (800) 478-0331 |
| NPI Number | 1487955977 |
|---|---|
| Provider Enumeration Date | 11/15/2010 |
| Last Update Date | 07/29/2021 |
| Certification Date | 07/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487955977 | NPI | - | NPPES |
| 060311210 | Medicaid | FL |
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