Healthcare Provider Details

I. General information

NPI: 1003159294
Provider Name (Legal Business Name): 433 ORANGE DRIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 ORANGE DR
ALTAMONTE SPRINGS FL
32701-5377
US

IV. Provider business mailing address

13770 58TH ST N STE 312
CLEARWATER FL
33760-3759
US

V. Phone/Fax

Practice location:
  • Phone: 407-260-2433
  • Fax:
Mailing address:
  • Phone: 727-726-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL7103
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL7103
License Number StateFL

VIII. Authorized Official

Name: DENNIS FORTE
Title or Position: MANAGER
Credential:
Phone: 727-726-3980