Organization
ELDERCLUB PORT RICHEY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVAKE ABRAHAM (OWNER)
(813) 406-0044
Entity
Organization
Contact information
Practice address
9735 US HIGHWAY 19, PORT RICHEY, FL 34668-3846
(727) 484-7199
Mailing address
4910 E ADAMO DR UNIT B, TAMPA, FL 33605-5920
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/02/2024
Last updated
02/08/2024
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