Provider Demographics
NPI:1205178258
Name:PATRICIA'S ROCK
Entity Type:Organization
Organization Name:PATRICIA'S ROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D/P
Authorized Official - Prefix:
Authorized Official - First Name:DE LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAPARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-566-1975
Mailing Address - Street 1:4325 FOUNTAINVIEW LN
Mailing Address - Street 2:#5102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1198
Mailing Address - Country:US
Mailing Address - Phone:904-566-1975
Mailing Address - Fax:
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:407-758-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-17
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management