Healthcare Provider Details

I. General information

NPI: 1770325136
Provider Name (Legal Business Name): ORDEAN MARTINS SOCIAL & RECREATIONAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CANAL ST S UNIT 816
BELLE GLADE FL
33430-2942
US

IV. Provider business mailing address

800 W CANAL ST S UNIT 816
BELLE GLADE FL
33430-2942
US

V. Phone/Fax

Practice location:
  • Phone: 561-493-4653
  • Fax:
Mailing address:
  • Phone: 561-493-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TARASGELA M. WILSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-493-4653