=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639289036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRINCETON PROFESSIONAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 COURTLAND ST # 300
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-691-8200
-----------------------------------------------------
Fax | 407-691-8222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 COURTLAND ST # 300
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-1332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-691-8200
-----------------------------------------------------
Fax | 407-691-8222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOROFFICER
-----------------------------------------------------
Name | BRYAN STILTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-691-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 20383096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------