Healthcare Provider Details

I. General information

NPI: 1457871204
Provider Name (Legal Business Name): EMBRACE COMMUNITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SW FAIRWAY DR
KEYSTONE HEIGHTS FL
32656-9506
US

IV. Provider business mailing address

260 SW FAIRWAY DR
KEYSTONE HEIGHTS FL
32656-9506
US

V. Phone/Fax

Practice location:
  • Phone: 352-727-9304
  • Fax:
Mailing address:
  • Phone: 352-727-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. KASSANDRA BRYAN
Title or Position: CEO
Credential:
Phone: 352-727-9304