Organization
ASGARD AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY COSTANZO (DIRECTOR)
(954) 551-7730
Entity
Organization
Contact information
Practice address
6109 W KNIGHTS GRIFFIN RD, PLANT CITY, FL 33565-3717
(954) 551-7730
Mailing address
4501 3RD AVE S, ST PETERSBURG, FL 33711-1017
(954) 551-7730
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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