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General NPI Number Information
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NPI Number | 1851735724
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Entity Type | Organization
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Legal Business Name | KONRAD MCCREE JR
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 8945 ENCHANTMENT DR
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City | LARGO
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State | FL
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Zip | 33773-4802
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Country | US
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Telephone | 727-271-7129
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 CLEARVIEW LAKE DR
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City | CLEARWATER
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State | FL
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Zip | 33755-1612
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Country | US
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Telephone | 727-271-7129
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. KONRAD MCCREE JR.
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Credential |
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Telephone | 727-271-7129
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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 |
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License Number State |
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