Provider Demographics
NPI:1235573262
Name:PLASTIC ENTERPRISE, INC
Entity Type:Organization
Organization Name:PLASTIC ENTERPRISE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-883-4347
Mailing Address - Street 1:4715 LANGDALE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2081
Mailing Address - Country:US
Mailing Address - Phone:407-883-4347
Mailing Address - Fax:
Practice Address - Street 1:4715 LANGDALE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2081
Practice Address - Country:US
Practice Address - Phone:407-883-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health