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General NPI Number Information
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NPI Number | 1407017403
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Entity Type | Organization
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Legal Business Name | SPECIAL TRAINING & REHABILITATION OF CHARLOTTE COUNTY INC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 525 BOWMAN TER
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City | PORT CHARLOTTE
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State | FL
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Zip | 33953-2186
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Country | US
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Telephone | 941-629-5655
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Fax |
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Provider Business Mailing Address
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Address Line | 525 BOWMAN TER
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City | PORT CHARLOTTE
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State | FL
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Zip | 33953-2186
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Country | US
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Telephone | 941-629-5655
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BRYAN G LANEUVILLE
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Credential |
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Telephone | 941-629-5655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 024708198
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License Number State | FL
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