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General NPI Number Information
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NPI Number | 1124685342
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Entity Type | Organization
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Legal Business Name | STONEY MAE EMPOWERMENT HOUSE FLORIDA
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 02/01/2020
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Provider Practice Location Address
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Address Line | 5724 BYRON ANTHONY PL APT 146
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City | SANFORD
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State | FL
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Zip | 32771-8627
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Country | US
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Telephone | 215-796-7157
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 BULLOCK AVE APT C
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City | YEADON
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State | PA
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Zip | 19050-3826
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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 | MANAGER
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Name | RAMONA HUMBERT
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Credential |
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Telephone | 215-796-7157
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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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