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General NPI Number Information
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NPI Number | 1356788996
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Entity Type | Organization
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Legal Business Name | JEANETTE GADSDEN
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 1113 FLEETWOOD DR NW
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2001
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Country | US
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Telephone | 941-743-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 FLEETWOOD DRIVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANETTE GADSDEN
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Credential |
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Telephone | 941-743-0897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906148
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License Number State | FL
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