Eddrena Thornton, owner
Custodial Care Facility, Adult Care Home in Bartow, FL. Individual provider (NPI-1).
NPI number1336747658
StatusActive
Last updated in NPPESOct 10, 2020
Details
- NPI
- 1336747658
- Entity type
- Individual (NPI-1)
- Name
- Eddrena Thornton
- Credential
- owner
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 9, 2020
- Certification date
- Oct 10, 2020
- Last updated
- Oct 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311ZA0620X | Custodial Care Facility, Adult Care Home | 6907032 | FL | Yes |
Practice location
2233 Bluebird AveBartow, FL 33830-2953
Phone 863-529-3103
Mailing address
2233 Bluebird AveBartow, FL 33830-2953
Phone 863-529-3103
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