Healthcare Provider Details

I. General information

NPI: 1609640382
Provider Name (Legal Business Name): THE FLORIDA INSTITUTE FOR COMMUNITY INCLUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 AULIN AVE
OVIEDO FL
32765-9401
US

IV. Provider business mailing address

365 AULIN AVE
OVIEDO FL
32765-9401
US

V. Phone/Fax

Practice location:
  • Phone: 407-577-0494
  • Fax:
Mailing address:
  • Phone: 407-577-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA B JESTER
Title or Position: EXECUTIVE DIRECTOR
Credential: CESP
Phone: 407-577-0494