Organization
GLADYS B HOUSE, LLC
Active
Other names
Gladys B House, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN MCLEAN (EXECUTIVE DIRECTOR)
(813) 528-6979
Entity
Organization
Contact information
Practice address
12875 SW 280TH ST, HOMESTEAD, FL 33032
(813) 528-6979
Mailing address
12875 SW 280TH ST, HOMESTEAD, FL 33032
(813) 528-6979
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
347C00000X
Private Vehicle
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891221065
—
FL
Enumeration date
05/10/2017
Last updated
05/11/2017
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