Tequela Yashan Donaldson
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Sanderson, FL
NPI 1780154062 · NPPES record last updated Nov 29, 2018
Key facts
- NPI
- 1780154062
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Practice address
- 14044 Friendship PL
Sanderson, FL 32087-2489 - Phone
- (904) 408-6638
- Fax
- (904) 409-0012
- NPI assigned
- Nov 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
14044 Friendship PL
Sanderson, FL 32087-2489
Mailing address
PO Box 163
Sanderson, FL 32087-0163
Phone (904) 408-6638
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 735303 | Medicaid | FL |
Other providers in Sanderson, FL
- Cory Coleman
- Barbara Cox
- Gifted Touch LLC
- Rayandral N Givens
- Givens' Home Care and Essential Staffing
- Hands That Care Home Health LLC
- Honest Touch
All providers in Sanderson, FL · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.