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NPI Code Detail

MEDICARE: PRESERVERS OF DESTINIES INC

MEDICARE: PRESERVERS OF DESTINIES 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
1251B00000XCase Management Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1952793101
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESERVERS OF DESTINIES INC
Provider Business Mailing Address
First Line : 1621 E VINE ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-3730
Country : US
Telephone Number : 407-847-4152
Fax Number :
Provider Business Practice Location Address
First Line : 1621 E VINE ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-3730
Country : US
Telephone Number : 407-429-1144
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARISOL LUGO
Credential :
Telephone Number : 407-429-1144
Provider Enumeration Date : 02/25/2015
Last Update Date : 08/17/2021

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Directions to “PRESERVERS OF DESTINIES INC ” Practice Location

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