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General NPI Number Information
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NPI Number | 1740920081
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Entity Type | Organization
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Legal Business Name | MCBRIDE, DELORES
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 1502 MEADOWBROOK ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-5723
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Country | US
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Telephone | 863-243-2896
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 MEADOWBROOK ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-5723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DELORES MCBRIDE
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Credential |
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Telephone | 863-243-2896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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