Provider Demographics
NPI:1710496237
Name:SHEDEV COMMUNITY OUTREACH CENTER, INC
Entity Type:Organization
Organization Name:SHEDEV COMMUNITY OUTREACH CENTER, INC
Other - Org Name:PERSONAL TOUCH REHABILITATION AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIS-JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-637-1556
Mailing Address - Street 1:13194 US HIGHWAY 301 S STE 147
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7410
Mailing Address - Country:US
Mailing Address - Phone:813-677-8106
Mailing Address - Fax:
Practice Address - Street 1:11812 GILMERTON DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3929
Practice Address - Country:US
Practice Address - Phone:718-637-1556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEDEV COMMUNITY OUTREACH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty