Provider Demographics
NPI:1093257602
Name:STRENGTH PROVIDER
Entity Type:Organization
Organization Name:STRENGTH PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:GAMA
Authorized Official - Last Name:BMASSANGA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:305-494-4392
Mailing Address - Street 1:910 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-8121
Mailing Address - Country:US
Mailing Address - Phone:305-494-4392
Mailing Address - Fax:888-441-6806
Practice Address - Street 1:910 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-8121
Practice Address - Country:US
Practice Address - Phone:305-494-4392
Practice Address - Fax:888-441-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-02-0914251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685676496Medicaid