Individual
FRESHEN SCHAMMUA DOCILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9097 SW 4TH ST, BOCA RATON, FL 33433-4607
(561) 961-0112
(561) 961-0112
Mailing address
9097 SW 4TH ST, BOCA RATON, FL 33433-4607
(561) 758-2824
(561) 961-0112
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
04/15/2019
Last updated
04/15/2019
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