Organization
FLORIDA PREFERRED CARE DEVELOPMENTAL CENTERS I, INC
Active
Other names
Sandy Park Developmental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JAMIE LATTURE COLLIER (DIRECTOR OF REIMBURSEMENT)
(601) 607-7195
Entity
Organization
Contact information
Practice address
2975 GARDEN ST, NORTH FORT MYERS, FL 33917-1883
(239) 995-5833
(239) 995-4856
Mailing address
751 AVIGNON DR, SUITE I, RIDGELAND, MS 39157-5161
(601) 607-7195
(601) 607-7196
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
4071095
FL
Other
Enumeration date
08/16/2006
Last updated
08/22/2020
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