Provider Demographics
NPI:1548457179
Name:SUPPORTED EMPLOYMENT AND LIVING FACILITATORS, INC.
Entity type:Organization
Organization Name:SUPPORTED EMPLOYMENT AND LIVING FACILITATORS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-391-0939
Mailing Address - Street 1:2203 ANDRE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5772
Mailing Address - Country:US
Mailing Address - Phone:813-391-0939
Mailing Address - Fax:813-948-6002
Practice Address - Street 1:2203 ANDRE DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5772
Practice Address - Country:US
Practice Address - Phone:813-391-0939
Practice Address - Fax:813-948-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF=========001Medicaid