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Organization

BRANDON SPORTS AND AQUATICS CENTER, INC.

Active
Other names
High 5, Inc.
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CHARLES W. BURGESS JR. (CEO)
(813) 689-0908
Entity
Organization

Contact information

Practice address
405 BEVERLY BLVD, BRANDON, FL 33511-5507
(813) 689-0908
Mailing address
405 BEVERLY BLVD, BRANDON, FL 33511-5507
(813) 689-0908

Taxonomy

Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
120040300
FL
Enumeration date
09/23/2024
Last updated
01/07/2025
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