Individual provider · NPI-1

Gertrude Dorman

Assisted Living Facility · Port Charlotte, FL

NPI number1235890559
StatusActive
Last updated in NPPESJan 8, 2022

Details

NPI
1235890559
Entity type
Individual (NPI-1)
Name
Gertrude Dorman
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 8, 2022
Certification date
Jan 8, 2022
Last updated
Jan 8, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Practice location

21936 Beverly Ave
Port Charlotte, FL 33952-5429

Phone 941-467-2665

Mailing address

21936 Beverly Ave
Port Charlotte, FL 33952-5429

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