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General NPI Number Information
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NPI Number | 1104318435
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Entity Type | Organization
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Legal Business Name | PARK VIEW OF BRANDON LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 1502 BRYAN RD
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City | BRANDON
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State | FL
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Zip | 33511-6835
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Country | US
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Telephone | 813-502-6308
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 BRYAN RD
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City | BRANDON
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State | FL
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Zip | 33511-6835
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Country | US
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Telephone | 813-502-6308
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CHRISTINA JEAN ROBERSON
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Credential |
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Telephone | 813-786-9645
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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 | 13158
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License Number State | FL
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