Provider Demographics
NPI:1073946570
Name:OKEECHOBEE SENIOR SERVICES
Entity Type:Organization
Organization Name:OKEECHOBEE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLESPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-462-5180
Mailing Address - Street 1:1690 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4340
Mailing Address - Country:US
Mailing Address - Phone:863-462-5180
Mailing Address - Fax:863-462-5184
Practice Address - Street 1:1690 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4340
Practice Address - Country:US
Practice Address - Phone:863-462-5180
Practice Address - Fax:863-462-5184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF COUNTY COMMISIONERS OF OKEECHOBEE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL088046903Medicaid
FL088046902Medicaid