Provider Demographics
NPI:1699525246
Name:VALOR LAKES HEALTH LLC
Entity type:Organization
Organization Name:VALOR LAKES HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:512-535-7770
Mailing Address - Street 1:741 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2157
Mailing Address - Country:US
Mailing Address - Phone:407-725-0012
Mailing Address - Fax:407-209-0788
Practice Address - Street 1:12629 US 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8588
Practice Address - Country:US
Practice Address - Phone:407-725-0012
Practice Address - Fax:407-209-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty