Healthcare Provider Details

I. General information

NPI: 1700301678
Provider Name (Legal Business Name): OSCEOLA DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-4983
US

IV. Provider business mailing address

229 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-4983
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-5964
  • Fax: 407-442-0737
Mailing address:
  • Phone: 407-350-5964
  • Fax: 407-442-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARLOS I RODRIGUEZ
Title or Position: ADM
Credential:
Phone: 407-350-5964