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General NPI Number Information
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NPI Number | 1558545475
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Entity Type | Organization
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Legal Business Name | BISHOP GRADY VILLAS
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 03/01/2014
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Provider Practice Location Address
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Address Line | 401 BISHOP GRADY CT
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1538
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Country | US
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Telephone | 407-892-6078
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Fax | 407-892-8081
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Provider Business Mailing Address
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Address Line | 401 BISHOP GRADY CT
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1538
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Country | US
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Telephone | 407-892-6078
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Fax | 407-892-8081
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN CHARLES JOHNSON
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Credential |
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Telephone | 407-892-6078
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10398
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License Number State | FL
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