MEDICARE: SOUL COMMUNITY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942022538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL COMMUNITY CENTER INC

Provider Business Mailing Address
First Line	:	8140 COLLEGE PKWY STE 203
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5169
Country	:	US
Telephone Number	:	305-244-6234
Fax Number	:

Provider Business Practice Location Address
First Line	:	8140 COLLEGE PKWY STE 203
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5169
Country	:	US
Telephone Number	:	305-244-6234
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HECTOR PEREZ GONZALEZ
Credential	:
Telephone Number	:	305-244-6234

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	10/25/2024

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Directions to “SOUL COMMUNITY CENTER INC ” Practice Location

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