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General NPI Number Information
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NPI Number | 1649445842
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Entity Type | Organization
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Legal Business Name | MENTORING & MOTIVATING YOUTH OF AMERICA, INC.
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 475 FRIENDSHIP DR
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City | ORLANDO
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State | FL
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Zip | 32835-4407
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Country | US
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Telephone | 407-578-2993
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Fax | 407-578-4588
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Provider Business Mailing Address
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Address Line | 475 FRIENDSHIP DR
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City | ORLANDO
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State | FL
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Zip | 32835-4407
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Country | US
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Telephone | 407-578-2993
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Fax | 407-578-4588
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. STAN B. MORRIS
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Credential |
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Telephone | 407-578-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 50001043735
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License Number State | FL
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