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General NPI Number Information
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NPI Number | 1568479681
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Entity Type | Organization
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Legal Business Name | RAINTREE ASSISTED LIVING
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 620 EDENVILLE AVE
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City | CLEARWATER
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State | FL
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Zip | 33764-6338
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Country | US
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Telephone | 727-797-2018
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 SAKONNET CT
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City | BRANDON
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State | FL
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Zip | 33511-1858
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Country | US
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Telephone | 813-310-0711
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JACQUELINE HURT
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Credential | NHA
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Telephone | 813-310-0711
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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 | AL08681
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License Number State | FL
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