Healthcare Provider Details

I. General information

NPI: 1831642446
Provider Name (Legal Business Name): UCP OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2016
Last Update Date: 07/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 W DONEGAN AVE
KISSIMMEE FL
34741-2335
US

IV. Provider business mailing address

1221 W COLONIAL DR SUITE,300
ORLANDO FL
32804-7163
US

V. Phone/Fax

Practice location:
  • Phone: 407-852-3300
  • Fax:
Mailing address:
  • Phone: 407-852-3347
  • Fax: 407-420-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberOT14539
License Number StateFL

VIII. Authorized Official

Name: MRS. ROSINA PADILLA
Title or Position: RISK MANAGER
Credential:
Phone: 407-852-3347