Healthcare Provider Details

I. General information

NPI: 1619321726
Provider Name (Legal Business Name): FAMILY INTEGRATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E OSCEOLA PARKWAY
KISSIMMEE FL
34744
US

IV. Provider business mailing address

541 LAKE TIVOLI BLVD
KISSIMMEE FL
34741-3264
US

V. Phone/Fax

Practice location:
  • Phone: 407-720-4651
  • Fax:
Mailing address:
  • Phone: 407-483-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. JESUS TORRES SR.
Title or Position: MENTAL HEALTH
Credential:
Phone: 407-720-4651