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Organization
MAYBELLE GROUP HOME LLC
Active
Organization
MAYBELLE GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAVENEY GITTENS-WILLIAMS (ASSISTANT ADMINISTRATOR)
(813) 966-7399
Entity
Organization
Contact information
Practice address
7207 LAKESHORE DRIVE, TAMPA, FL 33604
(813) 966-7399
(813) 212-6002
Mailing address
7202 LAKESHORE DR, TAMPA, FL 33604
(813) 966-7399
(813) 212-6002
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251J00000X
Nursing Care Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
364SL0600X
Long-Term Care Clinical Nurse Specialist
Primary
—
NULL
364SL0600X
Long-Term Care Clinical Nurse Specialist
Primary
—
—
Other
Enumeration date
01/26/2024
Last updated
01/26/2024
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