Individual
MR. RAYMOND B HENDRICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1306 ANNETTE ST, PORT CHARLOTTE, FL 33980
(941) 764-1572
Mailing address
1306 ANNETTE ST, PORT CHARLOTTE, FL 33980
(941) 764-1572
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906749
FL
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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