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General NPI Number Information
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NPI Number | 1750530994
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Entity Type | Organization
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Legal Business Name | PATRICIA A. CARSON
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 191 PATRICE HOPE ST
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City | LEESBURG
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State | FL
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Zip | 34748-7342
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Country | US
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Telephone | 352-504-8206
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Fax | 352-314-0039
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Provider Business Mailing Address
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Address Line | 191 PATRICE HOPE ST
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City | LEESBURG
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State | FL
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Zip | 34748-7342
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Country | US
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Telephone | 352-504-8206
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Fax | 352-314-0039
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA ANN CARSON
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Credential |
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Telephone | 352-504-8206
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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 | 692951696
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License Number State | FL
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