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General NPI Number Information
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NPI Number | 1235573262
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Entity Type | Organization
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Legal Business Name | PLASTIC ENTERPRISE, INC
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Dates
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Enumeration Date | 04/21/2013
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Last Update Date | 04/21/2013
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Provider Practice Location Address
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Address Line | 4715 LANGDALE DR
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City | ORLANDO
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State | FL
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Zip | 32808-2081
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Country | US
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Telephone | 407-883-4347
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 LANGDALE DR
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City | ORLANDO
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State | FL
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Zip | 32808-2081
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Country | US
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Telephone | 407-883-4347
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | JUDITH GERVAIS
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Credential |
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Telephone | 407-883-4347
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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