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General NPI Number Information
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NPI Number | 1780131276
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Entity Type | Organization
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Legal Business Name | CITRUS PINES ADULT FAMILY CARE, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 5618 N LECANTO HWY
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-2610
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Country | US
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Telephone | 352-513-2024
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Fax |
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Provider Business Mailing Address
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Address Line | 5618 N LECANTO HWY
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City | BEVERLY HILLS
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State | FL
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Zip | 34465
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Country | US
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Telephone | 352-513-2024
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL G KERN
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Credential |
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Telephone | 352-513-2024
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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 | 41679
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License Number State | FL
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