Healthcare Provider Details

I. General information

NPI: 1821256231
Provider Name (Legal Business Name): COOPERATIVE ADVENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 NW 6TH ST SUITE A
GAINESVILLE FL
32601-4245
US

IV. Provider business mailing address

1208 NW 6TH ST SUITE A
GAINESVILLE FL
32601-4245
US

V. Phone/Fax

Practice location:
  • Phone: 352-384-0909
  • Fax: 352-384-1752
Mailing address:
  • Phone: 352-384-0909
  • Fax: 352-384-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: GWENNE GORMAN
Title or Position: OWNER
Credential:
Phone: 352-384-0909