Organization
PROVIDENCE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA LAWRENCE-POKIMA (ADMINISTRATOR)
(407) 953-5657
Entity
Organization
Contact information
Practice address
8544 PARK HIGHLAND DR, ORLANDO, FL 32818-5770
(407) 953-5657
Mailing address
8544 PARK HIGHLAND DR, ORLANDO, FL 32818-5770
(407) 953-5657
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10413
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
687327800
—
FL
Enumeration date
07/10/2008
Last updated
07/10/2008
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