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General NPI Number Information
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NPI Number | 1053786806
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Entity Type | Organization
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Legal Business Name | COMFORT GARDENS,LLC
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 1108 BLACK KNIGHT DR
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City | VALRICO
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State | FL
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Zip | 33594-5800
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Country | US
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Telephone | 813-689-3707
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 BLACK KNIGHT DR
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City | VALRICO
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State | FL
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Zip | 33594-5800
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Country | US
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Telephone | 813-689-3707
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GLORYLYN T MANIAGO
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Credential | RN
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Telephone | 813-689-3707
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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 | AL12747
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License Number State | FL
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