MEDICARE: DESLIN ENTERPRISES, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1700094851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESLIN ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	998 W MAIN ST
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-3312
Country	:	US
Telephone Number	:	863-784-0464
Fax Number	:	863-784-0465

Provider Business Practice Location Address
First Line	:	998 W MAIN ST
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-3312
Country	:	US
Telephone Number	:	863-784-0464
Fax Number	:	863-784-0465

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DESI LEE
Credential	:
Telephone Number	:	863-784-0464

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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