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General NPI Number Information
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NPI Number | 1942791017
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Entity Type | Organization
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Legal Business Name | TRISTAN'S PLACE LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 4323 KINGSMILL CT
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-7056
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Country | US
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Telephone | 813-787-8803
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Fax |
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Provider Business Mailing Address
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Address Line | 4323 KINGSMILL CT
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-7056
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Country | US
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Telephone | 813-787-8803
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | TASHANA KIRKLAND-WILLIAMS
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Credential |
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Telephone | 813-787-8803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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