Healthcare Provider Details

I. General information

NPI: 1275998700
Provider Name (Legal Business Name): MENDING FENCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 W HIGHWAY 326
MORRISTON FL
32668-7311
US

IV. Provider business mailing address

15530 W HIGHWAY 326
MORRISTON FL
32668-7311
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-1300
  • Fax: 352-528-0651
Mailing address:
  • Phone: 352-528-1300
  • Fax: 352-528-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TILMAN MEARS
Title or Position: INTERIM CEO
Credential:
Phone: 352-528-2801