Healthcare Provider Details

I. General information

NPI: 1164295937
Provider Name (Legal Business Name): ROAD OPENER GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 GUADLUPE ST
HAINES CITY FL
33844
US

IV. Provider business mailing address

109 AMBERSWEET WAY # 336
DAVENPORT FL
33897-8418
US

V. Phone/Fax

Practice location:
  • Phone: 954-257-7112
  • Fax:
Mailing address:
  • Phone: 954-257-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATASHA VR KELLY
Title or Position: OWNER
Credential:
Phone: 954-257-7112