Provider Demographics
NPI:1891204319
Name:SOUTH WEST FLORIDA PODS ANGELS FAMILY SUPPORT GROUP, INC.
Entity Type:Organization
Organization Name:SOUTH WEST FLORIDA PODS ANGELS FAMILY SUPPORT GROUP, INC.
Other - Org Name:THE LABELLE DISCOVERY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-872-4778
Mailing Address - Street 1:1730 IVAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-5807
Mailing Address - Country:US
Mailing Address - Phone:239-872-4778
Mailing Address - Fax:
Practice Address - Street 1:136 S INDUSTRIAL LOOP # 6
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:239-872-4778
Practice Address - Fax:863-674-1493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services