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General NPI Number Information
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NPI Number | 1679944466
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Entity Type | Organization
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Legal Business Name | GARDEN OASIS ALF, LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 515 HICKORY LAKE DR
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City | BRANDON
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State | FL
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Zip | 33511-6337
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Country | US
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Telephone | 813-699-4142
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Fax | 813-413-7740
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Provider Business Mailing Address
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Address Line | 515 HICKORY LAKE DR STE B
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City | BRANDON
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State | FL
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Zip | 33511-6337
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Country | US
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Telephone | 813-330-8424
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Fax | 813-315-8233
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Authorized Official
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Title or Position | OWNER
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Name | GLADYS KANODEREKA
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Credential | RN
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Telephone | 813-530-0909
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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 | AL12249
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License Number State | FL
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