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Organization Active NPI Mental Illness Community Based Residential Treatment Facility · St Petersburg, FL
NPI 1851626337 · NPPES record last updated Oct 16, 2009
Key facts
- NPI
- 1851626337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- AL11427 (FL)
- Legal business name
- ACTIVE CARE GROUP HOME
- Practice address
- 3935 43Rd Ave N
St Petersburg, FL 33714-3620 - Phone
- (727) 235-8753
- NPI assigned
- Oct 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Esmeralda Manukonda
- Title
- President
- Phone
- (727) 452-0448
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | AL11427 | FL | Yes |
Addresses
Primary practice location
3935 43Rd Ave N
St Petersburg, FL 33714-3620
Mailing address
3935 43Rd Ave N
St Petersburg, FL 33714-3620
Phone (727) 235-8753
Other providers in St Petersburg, FL
- Urenna J Acholonu
- Lauren Acker
- Brian Evan Ackerman
- Jason Ackley
- Romeo Acosta Jr.
- Acupuncture & Herbal Therapies
- Acupuncture Alchemy Chartered
- Adam S. Di Dio, M.D., P.a.
- Christina Adams
- Lauren Kelly Adams
All providers in St Petersburg, FL · Mental Illness 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 Oct 16, 2009. 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.