Provider Demographics
NPI:1518302744
Name:KIP & ASSOCIATES
Entity Type:Organization
Organization Name:KIP & ASSOCIATES
Other - Org Name:THE VIEW AT CASSELBERRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTUONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:321-279-5197
Mailing Address - Street 1:369 FAIRGREEN PLACE
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707
Mailing Address - Country:US
Mailing Address - Phone:321-279-5197
Mailing Address - Fax:
Practice Address - Street 1:369 FAIRGREEN PL
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5205
Practice Address - Country:US
Practice Address - Phone:321-279-5197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12344320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12344OtherAGENCY FOR HEALTH CARE ADMINISTRATION