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General NPI Number Information
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NPI Number | 1003411265
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Entity Type | Organization
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Legal Business Name | SPRING OF LIGHT HOMES LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 405 ELLEN WAY
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City | BRANDON
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State | FL
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Zip | 33510-3220
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Country | US
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Telephone | 505-307-5837
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Fax |
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Provider Business Mailing Address
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Address Line | 405 ELLEN WAY
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City | BRANDON
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State | FL
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Zip | 33510-3220
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Country | US
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Telephone | 505-307-5837
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE/ OWNER
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Name | YORDANYS VALDES
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Credential | RN
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Telephone | 505-307-5837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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