Healthcare Provider Details

I. General information

NPI: 1770394736
Provider Name (Legal Business Name): SHIP COMMUNITY DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 ANDRUS AVE STE D
ORLANDO FL
32810-5456
US

IV. Provider business mailing address

5222 ANDRUS AVE STE D
ORLANDO FL
32810-5456
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-5022
  • Fax:
Mailing address:
  • Phone: 407-745-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OMUSI RANGER
Title or Position: PRESIDENT
Credential:
Phone: 407-683-0177