Organization
HIDDEN LAKES LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN PRUDEN (BUSINESS OFFICE DIRECTOR)
(941) 254-7990
Entity
Organization
Contact information
Practice address
1200 54TH AVENUE DR W, BRADENTON, FL 34207-3325
(941) 254-7990
Mailing address
1200 54TH AVENUE DR W, BRADENTON, FL 34207-3325
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
12337
FL
Other
Enumeration date
10/04/2013
Last updated
10/04/2013
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