Organization
BISHOP GRADY VILLAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN CHARLES JOHNSON (EXECUTIVE DIRECTOR)
(407) 892-6078
Entity
Organization
Contact information
Practice address
401 BISHOP GRADY CT, SAINT CLOUD, FL 34769-1538
(407) 892-6078
(407) 892-8081
Mailing address
401 BISHOP GRADY CT, SAINT CLOUD, FL 34769-1538
(407) 892-6078
(407) 892-8081
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
310400000X
Assisted Living Facility
Primary
AL10398
FL
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142955800
—
FL
05
—
692217196
—
FL
05
—
692217198
—
FL
Enumeration date
12/27/2007
Last updated
03/01/2014
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