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General NPI Number Information
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NPI Number | 1770976649
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Entity Type | Organization
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Legal Business Name | LOUISA GROUP LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 5700 24TH ST E
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City | BRADENTON
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State | FL
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Zip | 34203-4940
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Country | US
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Telephone | 417-230-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 18229 OHARA DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-9537
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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 | DANIEL ENGELHARDT
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Credential |
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Telephone | 315-416-9191
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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 |
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License Number State | FL
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