Organization
GARDENS RETREAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER LESLIE ELLIS ADM. (ADMINISTRATOR)
(772) 287-9713
Entity
Organization
Contact information
Practice address
4405 SW 72ND AVE, PALM CITY, FL 34990
(772) 287-9713
(772) 287-9713
Mailing address
4405 SW 72ND AVE, PALM CITY, FL 34990-5368
(772) 287-9713
(772) 287-9713
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
AL11039
FL
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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