Provider Demographics
NPI:1548025299
Name:DIFFERENT SKILLS 4 DIFFERENT MINDSETS FOUNDATION INC
Entity type:Organization
Organization Name:DIFFERENT SKILLS 4 DIFFERENT MINDSETS FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-432-7222
Mailing Address - Street 1:988 STUCKI TER
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4237
Mailing Address - Country:US
Mailing Address - Phone:407-432-7222
Mailing Address - Fax:
Practice Address - Street 1:1849 AMERICANA BLVD APT 35K
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2225
Practice Address - Country:US
Practice Address - Phone:407-432-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator