Organization
BREAKWATER ADULT FAMILY CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VINCE L JACOBS (OWNER-PROVIDER)
(352) 465-4877
Entity
Organization
Contact information
Practice address
22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431-4039
(352) 465-4877
(352) 465-8033
Mailing address
22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431-4039
(352) 465-4877
(352) 465-8033
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6905655
FL
Other
Enumeration date
03/07/2006
Last updated
08/22/2020
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