Basic Information
| Provider Information | |||||||||
| NPI: | 1356505028 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETA CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4680 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328071182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072771942 | ||||||||
| FaxNumber: | 4073810907 | ||||||||
| Practice Location | |||||||||
| Address1: | 4680 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328071182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072771942 | ||||||||
| FaxNumber: | 4073810907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | HOPE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4072771942 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | 5880123181331 | FL | Y | Agencies | Voluntary or Charitable |
No ID Information.