Organization
JEANETTE GADSDEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE GADSDEN (OWNER)
(941) 743-0897
Entity
Organization
Contact information
Practice address
1113 FLEETWOOD DR NW, PORT CHARLOTTE, FL 33948-2001
(941) 743-0897
Mailing address
1113 FLEETWOOD DRIVE, PORT CHARLOTTE, FL 33948
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142896900
—
FL
Enumeration date
05/22/2013
Last updated
05/22/2013
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