Organization
ICI
Active
Organization
ICI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SVETLANA KOROTKEVICH (REG AGENT)
(352) 222-8968
Entity
Organization
Contact information
Practice address
9462 SW 31ST LN, GAINESVILLE, FL 32608-7921
(352) 222-8968
Mailing address
9462 SW 31ST LN, GAINESVILLE, FL 32608-7921
(352) 222-8968
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/01/2011
Last updated
02/01/2011
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