Organization
EDENVILLE MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PROSPER K BONUEDIE (ADMINISTRATOR)
(727) 726-7242
Entity
Organization
Contact information
Practice address
721 EDENVILLE AVE, CLEARWATER, FL 33764-6339
(727) 726-7242
(727) 726-7211
Mailing address
721 EDENVILLE AVE, CLEARWATER, FL 33764-6339
(727) 726-7242
(727) 726-7211
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL 11968190
FL
Other
Enumeration date
02/29/2012
Last updated
02/29/2012
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