Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATRICIE E FREEMAN (COTA)
(321) 945-0713
Entity
Organization
Contact information
Practice address
15204 W COLONIAL DR, WINTER GARDEN, FL 34787-6042
(407) 877-2394
Mailing address
15204 W COLONIAL DR, WINTER GARDEN, FL 34787-6042
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
OTA9873
FL
Other
Enumeration date
05/26/2012
Last updated
05/26/2012
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