Provider Demographics
NPI:1578389284
Name:MELBA LEE INC
Entity type:Organization
Organization Name:MELBA LEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-770-0312
Mailing Address - Street 1:1101 WILLOW PINES CT E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6449
Mailing Address - Country:US
Mailing Address - Phone:813-542-6000
Mailing Address - Fax:813-533-6791
Practice Address - Street 1:1101 WILLOW PINES CT E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6449
Practice Address - Country:US
Practice Address - Phone:813-542-6000
Practice Address - Fax:813-533-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services