| Step Up On Second Street, Inc | |
|
1500 W 25th St Sanford FL 32771-4190 | |
| (470) 462-3330 | |
| Not Available |
| Full Name | Step Up On Second Street, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1500 W 25th St, Sanford, Florida |
| Authorized Official Name and Position | David Mark Tavlin (CHIEF PROGRAM OFFICER) |
| Authorized Official Contact | 3109855250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Step Up On Second Street, Inc 1500 W 25th St Sanford FL 32771-4190 Ph: (470) 462-3330 | Step Up On Second Street, Inc 1500 W 25th St Sanford FL 32771-4190 Ph: (470) 462-3330 |
| NPI Number | 1548978430 |
|---|---|
| Provider Enumeration Date | 11/09/2022 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548978430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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