Individual
MRS. CAROL ALTHEA LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12101 RONDA LN, NORTH PORT, FL 34287-1468
(941) 426-7707
(941) 426-7707
Mailing address
12101 RONDA LN, NORTH PORT, FL 34287-1468
(941) 426-7707
(941) 426-7707
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6905687
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417657
—
FL
Enumeration date
06/03/2013
Last updated
06/03/2013
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