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General NPI Number Information
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NPI Number | 1235314915
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Entity Type | Organization
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Legal Business Name | FLORRY CREATIVE CARE CORPORATION
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 415 N WILDER RD
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City | PLANT CITY
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State | FL
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Zip | 33566-7544
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Country | US
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Telephone | 813-441-4761
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Fax | 866-240-5666
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Provider Business Mailing Address
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Address Line | PO BOX 5636
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City | PLANT CITY
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State | FL
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Zip | 33563-0047
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Country | US
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Telephone | 813-650-8242
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Fax | 813-650-8242
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MS. CHERRY KAY HALLBACK
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Credential |
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Telephone | 813-650-8242
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 692691696
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL11825
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License Number State | FL
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