Organization
IVY FLO MOORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVY FLO MOORE (OWNER)
(941) 627-5983
Entity
Organization
Contact information
Practice address
23145 GRAY AVE, PORT CHARLOTTE, FL 33980-8587
(941) 627-5983
Mailing address
23145 GRAY AVE, PORT CHARLOTTE, FL 33980-8587
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906285
FL
Other
Enumeration date
01/21/2014
Last updated
01/21/2014
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