Healthcare Provider Details

I. General information

NPI: 1053593145
Provider Name (Legal Business Name): BEEHIVE MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11214 DESOTO RD
RIVERVIEW FL
33578-4515
US

IV. Provider business mailing address

11214 DESOTO RD
RIVERVIEW FL
33578-4515
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-3163
  • Fax: 813-333-5930
Mailing address:
  • Phone: 813-677-3163
  • Fax: 813-333-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. AVELINO T GARCIA
Title or Position: GENERAL MANAGER
Credential:
Phone: 813-918-5880