Organization
YARD 58 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE REEVES (OWNER)
(727) 564-6494
Entity
Organization
Contact information
Practice address
119 BELLEAIR PL, CLEARWATER, FL 33756-2601
(727) 564-6494
Mailing address
119 BELLEAIR PL, CLEARWATER, FL 33756-2601
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12345
—
FL
Enumeration date
12/06/2022
Last updated
02/28/2023
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