Wise Future Group Support Services, Llc | |
10244 E Colonial Dr Ste 110 Orlando FL 32817-4365 | |
(407) 202-9440 | |
(407) 203-4710 |
Full Name | Wise Future Group Support Services, Llc |
---|---|
Speciality | Clinic/Center |
Location | 10244 E Colonial Dr Ste 110, Orlando, Florida |
Authorized Official Name and Position | Yaznelly S Rivera (CEO) |
Authorized Official Contact | 4075087374 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Wise Future Group Support Services, Llc 2307 Greenwillow Dr Orlando FL 32825-7572 Ph: (407) 508-7374 | Wise Future Group Support Services, Llc 10244 E Colonial Dr Ste 110 Orlando FL 32817-4365 Ph: (407) 202-9440 |
NPI Number | 1770181638 |
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Provider Enumeration Date | 10/13/2020 |
Last Update Date | 08/15/2024 |
Certification Date | 08/15/2024 |
Medicare PECOS PAC ID | 5597120626 |
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Medicare Enrollment ID | O20230425001633 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770181638 | NPI | - | NPPES |
110237900 | Medicaid | FL | |
110561900 | Medicaid | FL | |
019545700 | Medicaid | FL | |
101284000 | Medicaid | FL | |
016554600 | Medicaid | FL | |
110159900 | Medicaid | FL |
Provider Name | Jose E Piovanetti |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1851382881 PECOS PAC ID: 1355613340 Enrollment ID: I20170825002656 |
Provider Name | Efren Fischer |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1972954618 PECOS PAC ID: 1951766674 Enrollment ID: I20230503000648 |
Provider Name | Lyudmila Ambrose |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1245999028 PECOS PAC ID: 2668837287 Enrollment ID: I20230503001198 |
Provider Name | Savier Caldero |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114594512 PECOS PAC ID: 2163887795 Enrollment ID: I20230503001495 |
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