Organization
ADULT FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA RICHARDSON (OWNER/ADM)
(863) 223-8104
Entity
Organization
Contact information
Practice address
309 N WETMORE ST, LAKE WALES, FL 33853-4057
(863) 223-8104
Mailing address
309 N WETMORE ST, LAKE WALES, FL 33853-4057
(863) 223-8104
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008834600
—
FL
Enumeration date
08/21/2014
Last updated
08/27/2014
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