Provider Demographics
NPI:1770394736
Name:SHIP COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:SHIP COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMUSI
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-683-0177
Mailing Address - Street 1:5222 ANDRUS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:407-745-5022
Mailing Address - Fax:
Practice Address - Street 1:5222 ANDRUS AVE STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:407-745-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty