Provider Demographics
NPI:1457511248
Name:WAKE UP MENTORING, INC.
Entity Type:Organization
Organization Name:WAKE UP MENTORING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-770-7611
Mailing Address - Street 1:PO BOX 550116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32855-0116
Mailing Address - Country:US
Mailing Address - Phone:407-347-7396
Mailing Address - Fax:
Practice Address - Street 1:823 W CENTRAL BLVD
Practice Address - Street 2:#60
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1808
Practice Address - Country:US
Practice Address - Phone:407-836-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL03802013876251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management