Healthcare Provider Details

I. General information

NPI: 1104578087
Provider Name (Legal Business Name): TEACHING RESPECT UNITY & EQUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 PULASKI AVE
ORLANDO FL
32818-3944
US

IV. Provider business mailing address

PO BOX 91032
LAKELAND FL
33804-1032
US

V. Phone/Fax

Practice location:
  • Phone: 407-455-0311
  • Fax:
Mailing address:
  • Phone: 407-455-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LATISHA CLARKE
Title or Position: CEO
Credential:
Phone: 689-312-5974