# 98

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255658365
- **Authorized official:** MILO DFERIVAL CNA (CNA)
- **Authorized official phone:** (813) 410-7719

## Contact information

- **Practice address:** 11314 MAHOPAC RD, WEEKI WACHEE, FL 34614-3562
- **Practice address phone:** (813) 410-7719
- **Mailing address:** 11314 MAHOPAC RD, WEEKI WACHEE, FL 34614-3562
- **Mailing address phone:** (813) 410-7719

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | CNA27905 | FL | Yes |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | CNA27905 | FL | — |

## Other

- **Enumeration date:** 04/28/2010
- **Last updated:** 04/28/2010