Healthcare Provider Details

I. General information

NPI: 1760649412
Provider Name (Legal Business Name): CMFMC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WILLOW DR
ORLANDO FL
32807-3222
US

IV. Provider business mailing address

150 WILLOW DR
ORLANDO FL
32807-3222
US

V. Phone/Fax

Practice location:
  • Phone: 407-282-0556
  • Fax: 407-282-2231
Mailing address:
  • Phone: 407-282-0556
  • Fax: 407-282-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL4839
License Number StateFL

VIII. Authorized Official

Name: MR. PROSERFINO PATACSIL
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-282-0556