Healthcare Provider Details

I. General information

NPI: 1700066404
Provider Name (Legal Business Name): FRUITVILLE HOLDINGS-OPPIDAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 FRUITVILLE RD
SARASOTA FL
34232-1617
US

IV. Provider business mailing address

4024 FRUITVILLE RD
SARASOTA FL
34232-1617
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-9158
  • Fax: 941-371-9168
Mailing address:
  • Phone: 941-706-0339
  • Fax: 941-761-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY B SMITH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 941-706-0339