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General NPI Number Information
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NPI Number | 1851695399
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Entity Type | Organization
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Legal Business Name | FAMILY EXTENDED CARE OF PUNTA GORDA, INC
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Dates
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Enumeration Date | 12/24/2010
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Last Update Date | 12/24/2010
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Provider Practice Location Address
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Address Line | 22332 VICK ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2053
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Country | US
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Telephone | 941-627-5388
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Fax | 941-627-2007
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Provider Business Mailing Address
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Address Line | 22332 VICK ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2053
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Country | US
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Telephone | 941-627-5388
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Fax | 941-627-2007
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Authorized Official
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Title or Position | DIRECTOR OF QUALITY ASSURANCE
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Name | DEBRA M LEWIS
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Credential |
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Telephone | 239-247-3248
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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 | AL5016
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License Number State | FL
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