Organization
GUARDIAN COVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IJEOMA MUFORO PHARMD (PROGRAM DIRECTOR)
(813) 401-0612
Entity
Organization
Contact information
Practice address
11205 CREEKVIEW DR, RIVERVIEW, FL 33569-5157
(727) 337-0108
Mailing address
13611 ASHLAR SLATE PL, RIVERVIEW, FL 33579-2140
(813) 401-0612
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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