Healthcare Provider Details

I. General information

NPI: 1275602120
Provider Name (Legal Business Name): AGENCY FOR PERSONS WITH DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 NE WALDO RD
GAINESVILLE FL
32609-3900
US

IV. Provider business mailing address

1621 NE WALDO RD
GAINESVILLE FL
32609-3900
US

V. Phone/Fax

Practice location:
  • Phone: 352-955-5668
  • Fax: 352-955-6038
Mailing address:
  • Phone: 352-955-5668
  • Fax: 352-955-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number4093096
License Number StateFL

VIII. Authorized Official

Name: DON E. THOMAS
Title or Position: SUPERINTENDENT
Credential:
Phone: 352-955-5856