Healthcare Provider Details

I. General information

NPI: 1043039860
Provider Name (Legal Business Name): TRUE CHANGE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 KINGSPOINTE PKWY STE 13
ORLANDO FL
32819-6522
US

IV. Provider business mailing address

7901 KINGSPOINTE PKWY STE 13
ORLANDO FL
32819-6522
US

V. Phone/Fax

Practice location:
  • Phone: 786-318-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE MIGUEL FLEITES RODRIGUEZ
Title or Position: AMBR
Credential:
Phone: 786-318-8500