Organization
ACTIVE CARE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESMERALDA MANUKONDA (PRESIDENT)
(727) 452-0448
Entity
Organization
Contact information
Practice address
3935 43RD AVE N, ST PETERSBURG, FL 33714-3620
(727) 235-8753
Mailing address
3935 43RD AVE N, ST PETERSBURG, FL 33714-3620
(727) 235-8753
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
AL11427
FL
Other
Enumeration date
10/16/2009
Last updated
10/16/2009
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