Organization
KOZETTE CRAWFORD
Active
Other names
Good Ole Days Adult Living Facility
Organization subpart
No
Provider details
NPI number
Authorized official
KOZETTE CRAWFORD (ADMINISTRATOR)
(407) 748-8252
Entity
Organization
Contact information
Practice address
1504 BENNETT RD, ORLANDO, FL 32803-2468
(407) 748-8252
Mailing address
1504 BENNETT RD, ORLANDO, FL 32803-2468
(407) 748-8252
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12500
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017210400
—
FL
Enumeration date
09/28/2016
Last updated
09/28/2016
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