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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID RAFAEL RAMOS M.ED (OWNER)
(813) 869-0831
Entity
Organization

Contact information

Practice address
12912 BROOKCREST PL, RIVERVIEW, FL 33578-7565
(813) 869-0831
Mailing address
12912 BROOKCREST PL, RIVERVIEW, FL 33578-7565
(813) 869-0831

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
251E00000X
Home Health Agency
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
343900000X
Non-emergency Medical Transport (VAN)
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care

Other

Enumeration date
08/15/2023
Last updated
08/15/2023
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