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General NPI Number Information
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NPI Number | 1275289647
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Entity Type | Organization
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Legal Business Name | ONENESS 1, LLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 904 LYNNLEA LN
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-2815
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Country | US
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Telephone | 813-419-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 13678 SEA BRIDGE DRIVE
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City | HUDSON
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State | FL
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Zip | 34669
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Country | US
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Telephone | 414-526-1743
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MAUREEN PAYNE
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Credential |
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Telephone | 414-526-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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