Healthcare Provider Details

I. General information

NPI: 1043120553
Provider Name (Legal Business Name): COMFORT VILLA III INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6953 CRESCENT RIDGE RD
ORLANDO FL
32810-5020
US

IV. Provider business mailing address

6953 CRESCENT RIDGE RD
ORLANDO FL
32810-5020
US

V. Phone/Fax

Practice location:
  • Phone: 407-592-1724
  • Fax:
Mailing address:
  • Phone: 407-592-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RADICA ANNIE SOOKLALL RN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 407-592-1724