Healthcare Provider Details

I. General information

NPI: 1467805317
Provider Name (Legal Business Name): MARY MONPLAISIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 LOUVRE CT
KISSIMMEE FL
34759-3840
US

IV. Provider business mailing address

915 LOUVRE CT
KISSIMMEE FL
34759-3840
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-3712
  • Fax: 407-201-3712
Mailing address:
  • Phone: 407-201-3712
  • Fax: 407-201-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number253J00000X
License Number StateFL

VIII. Authorized Official

Name: MRS. MARY ELIZABETH MONPLAISIR
Title or Position: MEDICAL FOSTER PARENT
Credential:
Phone: 407-201-3712