Organization
HOME AGAIN OF SOUTHWEST FLORIDA,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA ASHLEY (PRESIDENT)
(941) 743-4857
Entity
Organization
Contact information
Practice address
1357 RAMSDEL ST, PORT CHARLOTTE, FL 33952-2887
(941) 743-4857
(800) 921-4989
Mailing address
PO BOX 380183, MURDOCK, FL 33938-0183
(941) 743-4857
(800) 921-4989
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
FL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
678473996
MEDICAID WAIVER
—
Enumeration date
12/13/2010
Last updated
12/13/2010
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