Organization · NPI-2

Divine Care Of Port Charlotte

Assisted Living Facility, Assisted Living, Behavioral Disturbances · Port Charlotte, FL

NPI number1235805847
StatusActive
Last updated in NPPESAug 23, 2021

Details

NPI
1235805847
Entity type
Organization (NPI-2)
Legal business name
Divine Care Of Port Charlotte
Organization subpart
No
Enumeration date
Aug 23, 2021
Certification date
Aug 23, 2021
Last updated
Aug 23, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances––Yes

Practice location

2532 Starlite Ln
Port Charlotte, FL 33952-5653

Phone 941-626-5409 · Fax 941-235-8770

Mailing address

2532 Starlite Ln
Port Charlotte, FL 33952-5653

Phone 941-626-5409 · Fax 941-235-8770

Authorized official

Marvet A Flowers Davis
Administrator
9416265409

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