Provider Demographics
NPI:1205604931
Name:GUIONS PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:GUIONS PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID WAIVER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-800-9589
Mailing Address - Street 1:1502 N DONNELLY ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2846
Mailing Address - Country:US
Mailing Address - Phone:352-720-3160
Mailing Address - Fax:
Practice Address - Street 1:721 BALMORAL CIR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5606
Practice Address - Country:US
Practice Address - Phone:352-435-7068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities