Provider Demographics
NPI:1437692738
Name:CORAL REEF ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:CORAL REEF ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WETMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-999-1011
Mailing Address - Street 1:6800 GULFPORT BLVD S
Mailing Address - Street 2:STE. 201-346
Mailing Address - City:S PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4180 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1113
Practice Address - Country:US
Practice Address - Phone:727-999-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9360261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care