Westside Group Home, Inc.

NPI 1588967723 - Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities - 320900000X

NPI Details
NPI 1588967723
Enumeration Date 12/09/2010
Last Updated 12/09/2010
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name ILIANA R ILIANA
Position PSD
Phone (941) 795-1084
Fax (941) 792-0385
Practice Location
2602 43RD ST W
BRADENTON FL, 34209-6212, US
Phone (941) 795-1084
Fax (941) 792-0385
Business Location
6304 1ST AVE W
BRADENTON FL, 34209-2331, US
Phone (941) 794-5759
Fax (941) 794-5759
Toxanomy
Taxonomy Code 320900000X
License State Florida
License Number 3209000000X
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According to our database, Westside Group Home, Inc. NPI is 1588967723, taxonomy code is 320900000X and license number is 3209000000X, license state is located at Florida. Westside Group Home, Inc. physically located at 2602 43rd St W, Bradenton FL, 34209-6212. NPI Number 1033115704 has the healthcare provider type.

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1588967723 NPI number is provided on an as is basis without warranty of any kind. 1588967723 is maintained by the National Plan & Provider Enumeration System. The contents of Westside Group Home, Inc. are for informational purposes only.