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General NPI Number Information
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NPI Number | 1497928774
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Entity Type | Organization
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Legal Business Name | NEW VUE LLC DBA KEY PINE VILLAGE
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 6457 W NORVELL BRYANT HWY
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-9413
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Country | US
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Telephone | 352-634-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 N RAINBOW LOOP
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City | LECANTO
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State | FL
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Zip | 34461-8893
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Country | US
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Telephone | 352-634-5221
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Fax |
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Authorized Official
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Title or Position | MGMR
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Name | MR. SCOTT GREINER
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Credential |
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Telephone | 352-634-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 4036096
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License Number State | FL
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