Organization
FLORIDA HOMESTYLE MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY C GROVE (CHIEF EXECUTIVE OFFICER)
(205) 541-9580
Entity
Organization
Contact information
Practice address
481 DAGAMA DR, CLERMONT, FL 34715-8037
(205) 541-9580
Mailing address
1105 SADIE RIDGE RD, CLERMONT, FL 34715-0069
(205) 541-9580
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109504600
—
FL
01
—
13002507
AGENCY FOR PERSONS WITH DISABILITIES - APD
FL
Enumeration date
06/30/2020
Last updated
08/22/2021
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