Organization
TUCAWILLA VILLA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE M HARRY RN/RD (OWNER/ADMINISTRATOR)
(407) 637-0273
Entity
Organization
Contact information
Practice address
995 TUSCAWILLA ROAD, WINTER SPRINGS, FL 32708
(407) 637-0273
Mailing address
995 TUSCAWILLA ROAD, WINTER SPRINGS, FL 32708
(407) 637-0273
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213000110783
BUSINESS TAX RECEIPT- FLORIDA DIVISION OF CORPORATION
FL
01
—
6906719
AHCA LICENSE FOR ADULT FAMILY CARE HOME-
FL
Enumeration date
03/10/2016
Last updated
03/10/2016
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