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General NPI Number Information
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NPI Number | 1396152963
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Entity Type | Organization
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Legal Business Name | GREEN ACRES
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 15820 ARCHER ST
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City | HUDSON
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State | FL
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Zip | 34667-3816
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Country | US
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Telephone | 727-861-2975
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Fax | 727-857-4533
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Provider Business Mailing Address
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Address Line | 15820 ARCHER ST
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City | HUDSON
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State | FL
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Zip | 34667-3816
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Country | US
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Telephone | 727-861-2975
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Fax | 727-857-4533
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Authorized Official
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Title or Position | OWNER/ADMINSTRATOR
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Name | LUZ T KALBARCZYK
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Credential |
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Telephone | 727-861-2975
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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 | AI8642
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AI8642
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License Number State | FL
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