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General NPI Number Information
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NPI Number | 1285814178
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Entity Type | Organization
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Legal Business Name | GARDENVIEW ALF
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 526 N MARY ELLA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32404-2323
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Country | US
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Telephone | 850-871-1611
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Fax | 850-874-0640
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Provider Business Mailing Address
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Address Line | 526 N MARY ELLA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32404-2323
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Country | US
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Telephone | 850-871-1611
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Fax | 850-874-0640
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. HALINA WOJTYNA
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Credential |
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Telephone | 850-871-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AL5223
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License Number State | FL
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