Provider Demographics
NPI:1073977393
Name:KEY OF LIGHT TROUBLED TEEN SERVICES
Entity Type:Organization
Organization Name:KEY OF LIGHT TROUBLED TEEN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL-GIUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-777-9428
Mailing Address - Street 1:9525 CASTLEFORD PT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10759 EMERALD CHASE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5876
Practice Address - Country:US
Practice Address - Phone:828-777-9428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health