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General NPI Number Information
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NPI Number | 1437673381
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Entity Type | Organization
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Legal Business Name | THE LOU BURDETTE CAREGIVER FUND
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1150 W MINNEOLA AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2054
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Country | US
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Telephone | 352-708-5544
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Fax | 352-536-2511
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Provider Business Mailing Address
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Address Line | 1150 W MINNEOLA AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2054
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Country | US
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Telephone | 352-708-5544
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Fax | 352-536-2511
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY LOU WIELOSZYNSKI
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Credential |
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Telephone | 352-255-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9365
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License Number State | FL
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