Healthcare Provider Details

I. General information

NPI: 1891396461
Provider Name (Legal Business Name): HILLENDALE CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27357 FRAMPTON AVE
BROOKSVILLE FL
34602-7306
US

IV. Provider business mailing address

13348 GOLF CREST CIR
TAMPA FL
33618-8659
US

V. Phone/Fax

Practice location:
  • Phone: 813-610-2982
  • Fax: 941-827-3546
Mailing address:
  • Phone: 813-610-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT MARTIN ROTH
Title or Position: OWNER
Credential:
Phone: 813-610-2982