Organization
FROM BOYS TO MEN GROUP HOME LLC
Active
Other names
JONATHAN BLANC
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN BLANC (OWNER)
(239) 357-0745
Entity
Organization
Contact information
Practice address
1403 SHADOW CREEK PL, BRANDON, FL 33510-2454
(239) 357-0745
Mailing address
1403 SHADOW CREEK PL, BRANDON, FL 33510-2454
(239) 357-0745
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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