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General NPI Number Information
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NPI Number | 1275834129
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Entity Type | Organization
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Legal Business Name | PRISON REHABILITATIVE INDUSTRIES & DIVERSIFIED ENTERPRISES
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 12425 28TH ST. N. SUITE 300
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City | ST. PETERSBURG
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State | FL
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Zip | 33716
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Country | US
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Telephone | 727-556-3300
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Fax | 727-570-3449
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Provider Business Mailing Address
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Address Line | 12425 28TH ST N SUITE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33716-1844
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Country | US
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Telephone | 727-556-3300
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Fax | 727-570-3449
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Authorized Official
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Title or Position | ASSISTANT SECRETARY TO THE BOARD
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Name | MISS DENISE KIMINKI
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Credential |
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Telephone | 727-556-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State | FL
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