Organization
NETTIE MAE BERRY FOUNDATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANDRA LAIMIKIA SIMMONS (OWNER)
(352) 258-3450
Entity
Organization
Contact information
Practice address
113 NE 39TH PL, GAINESVILLE, FL 32609-1717
(352) 258-3450
(352) 376-5474
Mailing address
113 NE 39TH PL, GAINESVILLE, FL 32609-1717
(352) 258-3450
(352) 376-5474
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
689678298
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
689678298
—
FL
Enumeration date
06/25/2008
Last updated
06/25/2008
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