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General NPI Number Information
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NPI Number | 1326436692
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Entity Type | Organization
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Legal Business Name | AZALEA OAKS PLACE
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 902 CHARLIE GRIFFIN RD
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City | PLANT CITY
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State | FL
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Zip | 33566-0512
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Country | US
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Telephone | 813-704-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 902 CHARLIE GRIFFIN RD
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City | PLANT CITY
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State | FL
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Zip | 33566-0512
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Country | US
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Telephone | 813-704-6504
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER AND ASSISTANT
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Name | MRS. DENA LEIGH MARTIN
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Credential |
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Telephone | 813-704-6504
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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 | AL12460
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License Number State | FL
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