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General NPI Number Information
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NPI Number | 1013467414
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Entity Type | Organization
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Legal Business Name | TRI COUNTY CARETAKERS LLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 10313 PLEASANT VIEW DR
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City | LEESBURG
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State | FL
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Zip | 34788-3853
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Country | US
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Telephone | 352-322-8572
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Fax | 855-817-9358
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Provider Business Mailing Address
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Address Line | 10313 PLEASANT VIEW DR
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City | LEESBURG
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State | FL
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Zip | 34788-3853
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Country | US
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Telephone | 352-322-8572
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Fax | 855-817-9358
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Authorized Official
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Title or Position | CEO
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Name | CAROL PATTERSON
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Credential |
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Telephone | 352-322-8572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 016953100
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License Number State | FL
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