Provider Demographics
NPI:1699274712
Name:RIGHT CHOICE SENIOR ACTIVITY CENTER LLC
Entity type:Organization
Organization Name:RIGHT CHOICE SENIOR ACTIVITY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-355-9524
Mailing Address - Street 1:590 RINEHART RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4800
Mailing Address - Country:US
Mailing Address - Phone:786-355-9524
Mailing Address - Fax:
Practice Address - Street 1:590 RINEHART RD UNIT 6
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4800
Practice Address - Country:US
Practice Address - Phone:786-355-9524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9410261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9410Medicaid