Healthcare Provider Details

I. General information

NPI: 1962881276
Provider Name (Legal Business Name): RICHARDSON ANOINTING HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708EAST PONDEROSA DR
LAKELAND FL
33810
US

IV. Provider business mailing address

708 EAST PONDEROSA DR
LAKELAND FL
33810
US

V. Phone/Fax

Practice location:
  • Phone: 863-398-0451
  • Fax: 863-603-8896
Mailing address:
  • Phone: 863-398-0451
  • Fax: 863-603-8896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number014133000
License Number StateFL

VIII. Authorized Official

Name: BERNESSA RICHARDSON
Title or Position: AGENCY
Credential:
Phone: 863-398-0451