Healthcare Provider Details

I. General information

NPI: 1609450295
Provider Name (Legal Business Name): MGR TECHNOLOGIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 DUNAWAY DR
VALRICO FL
33594-6780
US

IV. Provider business mailing address

PO BOX 6831
SEFFNER FL
33583-6831
US

V. Phone/Fax

Practice location:
  • Phone: 813-592-3232
  • Fax:
Mailing address:
  • Phone: 813-592-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE T RUCKER
Title or Position: COO
Credential:
Phone: 813-592-3232