Organization
PROCARE4LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA B COGHIEL RN (OWNER)
(813) 458-5371
Entity
Organization
Contact information
Practice address
121 VILLAVISTA CT, DAVENPORT, FL 33896-8638
(813) 458-5371
(888) 522-0011
Mailing address
121 VILLAVISTA CT, DAVENPORT, FL 33896-8638
(813) 458-5371
(888) 522-0011
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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