Organization
AVICA, LLC
Active
Other names
West Coast Support Services, Two Ravens
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA MICHELE DEWATERS (OWNER)
(727) 804-1442
Entity
Organization
Contact information
Practice address
8790 53RD WAY N, PINELLAS PARK, FL 33782-5180
(727) 804-1442
Mailing address
PO BOX 101, PINELLAS PARK, FL 33780-0101
(727) 214-0427
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
Other
Enumeration date
10/02/2017
Last updated
06/01/2021
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