Organization
SHADY ACRES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS BRENDA LEE LONG RN (ADMINISTRATOR)
(352) 303-2827
Entity
Organization
Contact information
Practice address
670 CR 782, WEBSTER, FL 33597-3512
(352) 568-0058
(352) 568-0082
Mailing address
670 CR 782, WEBSTER, FL 33597-3512
(352) 568-0058
(352) 568-0082
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9373
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140787200
—
FL
05
—
676605600
—
FL
Enumeration date
06/13/2010
Last updated
06/13/2010
Update your record
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