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General NPI Number Information
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NPI Number | 1912626664
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA URBAN LEAGUE HEALTH & WELLNESS CLINIC
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | 595 W CHURCH ST
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City | ORLANDO
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State | FL
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Zip | 32805-2285
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Country | US
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Telephone | 407-841-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 2804 BELCO DR
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City | ORLANDO
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State | FL
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Zip | 32808-3557
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Country | US
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Telephone | 407-841-7654
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | CORNELIA JAMES
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Credential |
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Telephone | 850-264-9021
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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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