Healthcare Provider Details

I. General information

NPI: 1295236701
Provider Name (Legal Business Name): YACNOREV COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL STE 119
ORLANDO FL
32805-3154
US

IV. Provider business mailing address

750 S ORANGE BLOSSOM TRL STE 119
ORLANDO FL
32805-3154
US

V. Phone/Fax

Practice location:
  • Phone: 407-558-5058
  • Fax: 844-246-6240
Mailing address:
  • Phone: 407-558-5058
  • Fax: 844-246-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: VERONICA BUNBURY
Title or Position: MANAGER/OWNER
Credential:
Phone: 407-558-5058