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NPI 1346681129 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Orange City, FL
Provider details
- NPI number
- 1346681129
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Craig Blair, Manager(386) 837-3125
- License
- 678316396 (FL)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 678316396 (FL)
Residential Treatment Facilities
Respite Care Facility
Practice location
211 N Sparkman Ave
Orange City, FL 32763-5011
Phone: (386) 775-2165
Fax: (386) 775-3165
Approximate (ZIP-level) locationGet directions
Mailing address
211 N Sparkman Ave
Orange City, FL 32763-5011
Registry dates
- Enumerated
- 2013-07-09
- Last updated
- 2013-07-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.