Provider Demographics
NPI:1477985539
Name:SIMEON RESOURCE AND DEVELOPMENT CENTER FOR MEN, INC
Entity Type:Organization
Organization Name:SIMEON RESOURCE AND DEVELOPMENT CENTER FOR MEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:407-574-5436
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL STE 30
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3138
Mailing Address - Country:US
Mailing Address - Phone:407-574-5436
Mailing Address - Fax:407-574-3779
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL STE 30
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3138
Practice Address - Country:US
Practice Address - Phone:407-574-5436
Practice Address - Fax:407-574-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management