Organization
98
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILO DFERIVAL CNA (CNA)
(813) 410-7719
Entity
Organization
Contact information
Practice address
11314 MAHOPAC RD, WEEKI WACHEE, FL 34614-3562
(813) 410-7719
Mailing address
11314 MAHOPAC RD, WEEKI WACHEE, FL 34614-3562
(813) 410-7719
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
CNA27905
FL
315P00000X
Intellectual Disabilities Intermediate Care Facility
CNA27905
FL
Other
Enumeration date
04/28/2010
Last updated
04/28/2010
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