Healthcare Provider Details

I. General information

NPI: 1437448560
Provider Name (Legal Business Name): INTERFAITH HUMANITARIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 WESTPOINTE BLVD SUITE 207
ORLANDO FL
32835-8757
US

IV. Provider business mailing address

7065 WESTPOINTE BLVD SUITE 207
ORLANDO FL
32835-8757
US

V. Phone/Fax

Practice location:
  • Phone: 407-532-9000
  • Fax:
Mailing address:
  • Phone: 407-532-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOMINIQUE MATHURIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 407-437-2034