Provider Demographics
NPI:1285814178
Name:GARDENVIEW ALF
Entity Type:Organization
Organization Name:GARDENVIEW ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJTYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-871-1611
Mailing Address - Street 1:526 N MARY ELLA AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2323
Mailing Address - Country:US
Mailing Address - Phone:850-871-1611
Mailing Address - Fax:850-874-0640
Practice Address - Street 1:526 N MARY ELLA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2323
Practice Address - Country:US
Practice Address - Phone:850-871-1611
Practice Address - Fax:850-874-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5223320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness