Provider Demographics
NPI:1114052933
Name:TRAUMATIC BRAIN EDUCATION ADULT COMMUNITY HOME
Entity Type:Organization
Organization Name:TRAUMATIC BRAIN EDUCATION ADULT COMMUNITY HOME
Other - Org Name:TEACH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-773-2857
Mailing Address - Street 1:PO BOX 1722
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-1722
Mailing Address - Country:US
Mailing Address - Phone:863-773-2857
Mailing Address - Fax:863-773-2041
Practice Address - Street 1:3858 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-9395
Practice Address - Country:US
Practice Address - Phone:863-773-2857
Practice Address - Fax:863-773-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL0008514310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility