Healthcare Provider Details

I. General information

NPI: 1962920595
Provider Name (Legal Business Name): SISTER WITH DESTINY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2017
Last Update Date: 09/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 N. O. B. T APT 103
ORLANDO FL
32810
US

IV. Provider business mailing address

PO BOX 682081
ORLANDO FL
32868
US

V. Phone/Fax

Practice location:
  • Phone: 407-545-1924
  • Fax: 407-545-1924
Mailing address:
  • Phone: 407-480-8392
  • 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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: GERALDINE SIMS
Title or Position: CEO OWNER
Credential:
Phone: 407-545-1924