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1770181638

NPI Code Detail

MEDICARE: WISE FUTURE GROUP SUPPORT SERVICES, LLC

MEDICARE: WISE FUTURE GROUP SUPPORT SERVICES, LLC

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	103K00000X	Behavior Analyst
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	261QC1500X	Community Health Clinic/Center
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770181638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE FUTURE GROUP SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	2307 GREENWILLOW DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7572
Country	:	US
Telephone Number	:	407-508-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	10244 E COLONIAL DR STE 110
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4365
Country	:	US
Telephone Number	:	407-202-9440
Fax Number	:	407-203-4710

Authorized Official
Title or Position	:	CEO
Name	:	YAZNELLY S RIVERA
Credential	:	MPA, MSCJ, CBHCMS
Telephone Number	:	407-508-7374

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	08/15/2024

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Practice Location Address:

10244 E COLONIAL DR STE 110
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32817-4365

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Practice Location Address:

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Practice Location Address:

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Directions to “WISE FUTURE GROUP SUPPORT SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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