The Source D.A.G.

LBN: The Source Of Americallc
The Source D.A.G. is an health care organization with primary practice located at 5301 Goddard Ave , Orlando FL 32810-5437. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as the primary health care specialty. The Source Of Americallc can be contacted via phone (407) 715-6807, or through White, Rick via phone (904) 703-4364.

Contact Information

Primary practice address
5301 Goddard Ave Orlando FL 32810-5437
Phone: (407) 715-6807
Fax:
Website:
Map and Directions
Authorized official contact:
Name: White, Rick
Phone: (904) 703-4364

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1942566393
LBN Legal business name The Source Of Americallc
DBA Doing business as The Source D.A.G.
Authorized official White, Rick
Entity Organization
Organization subpart 1 No
Enumeration date Apr 10th, 2012
Last updated Apr 10th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942566393 NPPES
Florida MEDICAID RAENISHA22

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