Organization
STROKE OF GRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMIAH FORTSON (ADMINISTRATOR/VICE PRESIDENT)
(813) 752-1470
Entity
Organization
Contact information
Practice address
4002 THONOTOSASSA RD, PLANT CITY, FL 33565-5916
(813) 752-1470
Mailing address
4002 THONOTOSASSA RD, PLANT CITY, FL 33565-5916
(813) 752-1470
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906634
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010829800
—
FL
Enumeration date
06/23/2014
Last updated
06/23/2014
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