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General NPI Number Information
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NPI Number | 1053593145
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Entity Type | Organization
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Legal Business Name | BEEHIVE MANOR LLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 11214 DESOTO RD
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City | RIVERVIEW
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State | FL
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Zip | 33578-4515
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Country | US
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Telephone | 813-677-3163
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Fax | 813-333-5930
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Provider Business Mailing Address
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Address Line | 11214 DESOTO RD
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City | RIVERVIEW
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State | FL
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Zip | 33578-4515
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Country | US
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Telephone | 813-677-3163
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Fax | 813-333-5930
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. AVELINO T GARCIA
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Credential |
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Telephone | 813-918-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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