Healthcare Provider Details

I. General information

NPI: 1619511391
Provider Name (Legal Business Name): JEWELS FAMILY SUCCESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 20TH ST
ORLANDO FL
32805-4632
US

IV. Provider business mailing address

5420 CHAPPARREL DR
ORLANDO FL
32839-5221
US

V. Phone/Fax

Practice location:
  • Phone: 407-706-7575
  • Fax:
Mailing address:
  • Phone: 407-706-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH FLETCHER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-706-7575