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General NPI Number Information
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NPI Number | 1801420369
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Entity Type | Organization
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Legal Business Name | CD-TT WILDWOOD LLC
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 1477 HUEY ST
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City | WILDWOOD
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State | FL
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Zip | 34785-4233
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Country | US
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Telephone | 352-251-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 958 20TH PL FL 2
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City | VERO BEACH
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State | FL
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Zip | 32960-6420
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Country | US
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Telephone | 772-492-5002
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Fax | 772-492-5005
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Authorized Official
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Title or Position | CFO FOR MANAGER
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Name | CHRIS COLLINS
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Credential |
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Telephone | 772-492-5002
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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 |
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