Organization
WE CARE LIFESOURCE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAVONDA MOORE HARGROVE (PRESIDENT)
(813) 766-0863
Entity
Organization
Contact information
Practice address
1004 E DR MARTIN LUTHER KING JR BLVD, PLANT CITY, FL 33563-5712
(813) 766-0863
Mailing address
1004 E DR MARTIN LUTHER KING JR BLVD, PLANT CITY, FL 33563-5712
(813) 766-0863
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
320900000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6932215 96
—
FL
05
—
6932215 98
—
FL
Enumeration date
06/06/2008
Last updated
06/06/2008
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