MEDICARE: PLASTIC ENTERPRISE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235573262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC ENTERPRISE, INC

Provider Business Mailing Address
First Line	:	4715 LANGDALE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2081
Country	:	US
Telephone Number	:	407-883-4347
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 LANGDALE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2081
Country	:	US
Telephone Number	:	407-883-4347
Fax Number	:

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	JUDITH GERVAIS
Credential	:
Telephone Number	:	407-883-4347

Provider Enumeration Date	:	04/21/2013
Last Update Date	:	04/21/2013

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Directions to “PLASTIC ENTERPRISE, INC ” Practice Location

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