Provider Demographics
NPI:1912626664
Name:CENTRAL FLORIDA URBAN LEAGUE HEALTH & WELLNESS CLINIC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA URBAN LEAGUE HEALTH & WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-264-9021
Mailing Address - Street 1:2804 BELCO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3557
Mailing Address - Country:US
Mailing Address - Phone:407-841-7654
Mailing Address - Fax:
Practice Address - Street 1:595 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2285
Practice Address - Country:US
Practice Address - Phone:407-841-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA URBAN LEAGUE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-25
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health