Provider Demographics
NPI:1497105902
Name:LENORA MAZON
Entity type:Organization
Organization Name:LENORA MAZON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-318-9681
Mailing Address - Street 1:211 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1915
Mailing Address - Country:US
Mailing Address - Phone:352-318-9681
Mailing Address - Fax:
Practice Address - Street 1:211 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1915
Practice Address - Country:US
Practice Address - Phone:352-318-9681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services