Healthcare Provider Details

I. General information

NPI: 1467918599
Provider Name (Legal Business Name): CAMEN ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S 8TH ST STE 120
FERNANDINA BEACH FL
32034-6700
US

IV. Provider business mailing address

2860 FALCONHILL DR
APOPKA FL
32712-2443
US

V. Phone/Fax

Practice location:
  • Phone: 407-413-6789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID AARON LOTTMAN
Title or Position: CFO
Credential:
Phone: 407-413-6789