Organization
MANASOTA ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIERDRA WALKER (PRESIDENT/CEO)
(727) 410-7859
Entity
Organization
Contact information
Practice address
4211 36TH AVE E, PALMETTO, FL 34221-8968
(941) 721-7684
Mailing address
4211 36TH AVE E, PALMETTO, FL 34221-8968
(941) 721-7684
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/08/2012
Last updated
03/08/2012
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