Healthcare Provider Details

I. General information

NPI: 1114320488
Provider Name (Legal Business Name): FREMONT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FREMONT AVE
WINTER PARK FL
32789-1729
US

IV. Provider business mailing address

909 FREMONT AVE
WINTER PARK FL
32789-1729
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-5335
  • Fax:
Mailing address:
  • Phone: 407-599-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL 9198
License Number StateFL

VIII. Authorized Official

Name: ARNOLD SANTOS
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-599-5335