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General NPI Number Information
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NPI Number | 1841534666
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Entity Type | Organization
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Legal Business Name | IRONHEAD RANCH, INC.
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 2605 SW BALDWIN ST
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City | ARCADIA
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State | FL
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Zip | 34266
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Country | US
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Telephone | 863-993-0612
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Fax | 863-491-0748
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | NOCATEE
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State | FL
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Zip | 34268-0575
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Country | US
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Telephone | 863-993-0612
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Fax | 863-491-0748
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EVA M LOWE
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Credential |
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Telephone | 863-491-0748
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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 | 11787
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License Number State | FL
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