Organization
MASTER CARE-GIVERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY BERNARD MCCOY JR. (CEO)
(352) 874-0639
Entity
Organization
Contact information
Practice address
13806 STATE ROAD 33, GROVELAND, FL 34736-9499
(352) 874-0639
Mailing address
13806 STATE ROAD 33, GROVELAND, FL 34736-9499
(352) 874-0639
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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