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General NPI Number Information
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NPI Number | 1073977393
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Entity Type | Organization
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Legal Business Name | KEY OF LIGHT TROUBLED TEEN SERVICES
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 10759 EMERALD CHASE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5876
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Country | US
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Telephone | 828-777-9428
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Fax |
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Provider Business Mailing Address
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Address Line | 9525 CASTLEFORD PT
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City | ORLANDO
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State | FL
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Zip | 32836-5766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER DEL-GIUDICE
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Credential |
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Telephone | 828-777-9428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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