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General NPI Number Information
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NPI Number | 1649610510
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Entity Type | Organization
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Legal Business Name | FRESH HORIZONS ALF
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 4836 35TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-1172
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Country | US
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Telephone | 772-564-7271
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Fax | 772-567-8361
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Provider Business Mailing Address
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Address Line | 4836 35TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-1172
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Country | US
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Telephone | 772-564-7271
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Fax | 772-567-8361
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BARBARA ANDREWS
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Credential |
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Telephone | 772-562-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | AL10323
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License Number State | FL
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