Organization
WISTERIA ELDERLY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WITZA LARIONNE (OWNER)
(321) 345-4177
Entity
Organization
Contact information
Practice address
189 DONALD AVE NE, PALM BAY, FL 32907-3158
(321) 345-4177
(321) 345-4177
Mailing address
189 DONALD AVE NE, PALM BAY, FL 32907-3158
(321) 345-4177
(321) 345-4177
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
232475
FL
385H00000X
Respite Care
Primary
6906533
FL
Other
Enumeration date
03/29/2013
Last updated
03/29/2013
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