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Intellectual and/or Developmental Disabilities Residential Treatment Facility · KISSIMMEE, FL

Individual Active NPI 1124772520

Taxonomy & licensure

Specialty	Code	Primary	License	State
Intellectual and/or Developmental Disabilities Residential Treatment Facility	320600000X	✓	692345396	FL
Mental Illness Community Based Residential Treatment Facility	320800000X		692345396	FL

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Source: NPPES (public domain) and CMS Medicare Physician & Other Practitioners data. Not affiliated with CMS, NPPES, or any government agency.