Organization
WOODGATE PLACE ALF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS VELMA WAJE TIZON (OWNER ADMINISTRATOR)
(727) 797-9678
Entity
Organization
Contact information
Practice address
2314 HAWTHORNE DR, CLEARWATER, FL 33763-1511
(727) 797-9678
(727) 796-5282
Mailing address
2314 HAWTHORNE DR, CLEARWATER, FL 33763-1511
(727) 797-9678
(727) 796-5282
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
FL
Other
Enumeration date
08/31/2007
Last updated
08/31/2007
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