Healthcare Provider Details

I. General information

NPI: 1366137341
Provider Name (Legal Business Name): FIG TREE OUTREACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7468 BORDWINE DR
ORLANDO FL
32818-3063
US

IV. Provider business mailing address

1317 EDGEWATER DR # 4436
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 678-755-2417
  • Fax:
Mailing address:
  • Phone: 678-755-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MISS TRESSA J JONES
Title or Position: DIRECTOR
Credential:
Phone: 678-755-2417