Healthcare Provider Details

I. General information

NPI: 1922204247
Provider Name (Legal Business Name): UNITED STATES FELLOWSHIP OF FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 COCO PLUM DR
MARATHON FL
33050-4015
US

IV. Provider business mailing address

1320 COCO PLUM DR
MARATHON FL
33050-4015
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-4129
  • Fax: 305-743-5137
Mailing address:
  • Phone: 305-743-4129
  • Fax: 305-743-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL8523
License Number StateFL

VIII. Authorized Official

Name: MRS. CLARE CONDRA
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-743-4129