Organization
SOCIETY OF ST. AGNES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ATUKUZWE VICTOR NYIRENDA (DIRECTOR)
(863) 644-6640
Entity
Organization
Contact information
Practice address
6012 CASON WAY, LAKELAND, FL 33812-3888
(863) 644-6640
(863) 709-0595
Mailing address
PO BOX 7422, LAKELAND, FL 33807-7422
(863) 644-6640
(863) 709-0595
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
14GH01351
FL
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
14GH01357
FL
Other
Enumeration date
01/03/2011
Last updated
01/03/2011
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