Organization
LOUISE GRAHAM REGENERATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARTHUR O'HARA (EXECUTIVE DIRECTOR)
(727) 578-5437
Entity
Organization
Contact information
Practice address
2301 3RD AVE S, ST PETERSBURG, FL 33712-1646
(727) 327-9444
(727) 327-9649
Mailing address
2301 3RD AVE S, ST PETERSBURG, FL 33712-1646
(727) 327-9444
(727) 327-9649
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024019201
—
FL
05
—
024019296
—
FL
Enumeration date
02/09/2011
Last updated
02/09/2011
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