Organization
BREAKWATER ADULT FAMILY CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCE JACOBS (OWNER)
(352) 598-0288
Entity
Organization
Contact information
Practice address
22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431-4039
(352) 401-7699
(352) 401-7698
Mailing address
22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431-4039
(352) 401-7699
(352) 401-7698
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
6905655
FL
Other
Enumeration date
12/29/2006
Last updated
08/22/2020
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