Healthcare Provider Details

I. General information

NPI: 1790963593
Provider Name (Legal Business Name): THE COTTAGES OF PT RICHEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 PINEHILL RD
PORT RICHEY FL
34668-6615
US

IV. Provider business mailing address

5905 PINEHILL RD
PORT RICHEY FL
34668-6615
US

V. Phone/Fax

Practice location:
  • Phone: 727-845-0527
  • Fax: 727-842-9485
Mailing address:
  • Phone: 727-845-0527
  • Fax: 727-842-9485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL5993
License Number StateFL

VIII. Authorized Official

Name: MR. DOUGLAS MATTHEW KLINOWSKI
Title or Position: PRESIDENT
Credential:
Phone: 727-845-0527