Organization
GENA OBRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENA OBRY (OWNER)
(863) 229-5419
Entity
Organization
Contact information
Practice address
439 AVENUE D SE, WINTER HAVEN, FL 33880-3531
(863) 229-5419
Mailing address
439 AVENUE D SE, WINTER HAVEN, FL 33880-3531
(863) 229-5419
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906588
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012306000
—
FL
Enumeration date
09/17/2014
Last updated
09/17/2014
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