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General NPI Number Information
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NPI Number | 1265836985
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Entity Type | Organization
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Legal Business Name | SHIRLEY WRIGHT DBA CLOBRAN ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 3 CLEAR PL
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City | OCALA
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State | FL
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Zip | 34472-2310
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Country | US
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Telephone | 352-680-1959
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Fax | 352-687-1806
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Provider Business Mailing Address
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Address Line | 4405 SW 102ND LANE RD
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City | OCALA
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State | FL
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Zip | 34476-4143
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Country | US
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Telephone | 352-873-8492
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Fax | 352-873-8492
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Authorized Official
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Title or Position | ADMININTRATOR
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Name | MRS. SHIRLEY MAY WRIGHT
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Credential |
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Telephone | 352-680-1959
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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 | AL10825
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License Number State | FL
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