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General NPI Number Information
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NPI Number | 1497092399
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Entity Type | Organization
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Legal Business Name | THE MENTORING CENTER, INCORPORATED
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/11/2013
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Provider Practice Location Address
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Address Line | 1715 DIVISION AVE
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6284
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Country | US
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Telephone | 678-571-1918
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Fax |
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Provider Business Mailing Address
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Address Line | 950 EVERNIA ST 315
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5735
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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 | EXECUTIVE DIRECTOR
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Name | DONALD F. WILSON
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Credential |
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Telephone | 678-571-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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