| Shalanda's House Inc | |
|
715 Almond Street Suite A Clermont FL 34711 | |
| (352) 931-1042 | |
| Not Available |
| Full Name | Shalanda's House Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 715 Almond Street Suite A, Clermont, Florida |
| Authorized Official Name and Position | Kimberly Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3529311042 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalanda's House Inc 715 Almond Street Suite A Clermont FL 34711 Ph: (352) 931-1042 | Shalanda's House Inc 715 Almond Street Suite A Clermont FL 34711 Ph: (352) 931-1042 |
| NPI Number | 1235815150 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Medicare PECOS PAC ID | 5890131312 |
|---|---|
| Medicare Enrollment ID | O20240306004465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235815150 | NPI | - | NPPES |
| Provider Name | Kimberly L Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578814166 PECOS PAC ID: 1557501335 Enrollment ID: I20130628000599 |
| Provider Name | Nakei Tameka Wright Powell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306199781 PECOS PAC ID: 1153761267 Enrollment ID: I20240506001884 |
| Provider Name | Samyra Deranell Addison Boney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669509121 PECOS PAC ID: 1658818075 Enrollment ID: I20240802003075 |
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