Provider Demographics
NPI:1457871204
Name:EMBRACE COMMUNITY CENTER INC
Entity Type:Organization
Organization Name:EMBRACE COMMUNITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-727-9304
Mailing Address - Street 1:260 SW FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9506
Mailing Address - Country:US
Mailing Address - Phone:352-727-9304
Mailing Address - Fax:
Practice Address - Street 1:260 SW FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9506
Practice Address - Country:US
Practice Address - Phone:352-727-9304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X, 253Z00000X, 261QC1500X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine