Provider Demographics
NPI:1477844751
Name:FOR THE COMMUNITY FLORIDA PLLC
Entity Type:Organization
Organization Name:FOR THE COMMUNITY FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENETTA
Authorized Official - Middle Name:TANICA
Authorized Official - Last Name:SLONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-628-4079
Mailing Address - Street 1:8721 W WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3605
Mailing Address - Country:US
Mailing Address - Phone:623-628-4079
Mailing Address - Fax:
Practice Address - Street 1:627 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6053
Practice Address - Country:US
Practice Address - Phone:623-628-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health