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General NPI Number Information
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NPI Number | 1376237685
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Entity Type | Organization
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Legal Business Name | OAK CREEK COTTAGE, LLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 13545 78TH PL N
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-2132
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Country | US
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Telephone | 561-818-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 13545 78TH PL N
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-2132
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Country | US
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Telephone | 561-818-5760
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MRS. ANGELA ATKINSON
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Credential | CRNA
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Telephone | 561-818-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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